Fournier's gangrene: Three years of experience with 20 patients and validity of the Fournier's Gangrene Severity Index Score

Altug Tuncel, Omur Aydin, Umit Tekdogan, Varol Nalcacioglu, Yusuf Capar, Ali Atan
European Urology 2006, 50 (4): 838-43

OBJECTIVE: To evaluate effective factors in the survival of patients with Fournier's gangrene (FG) and to determine the validity of the Fournier's Gangrene Severity Index (FGSI), which was designed for determining disease severity in these patients.

METHODS: The study included 20 men with a median age of 63.5 yr treated for FG between July 2002 and June 2005. The data were evaluated about medical history, symptoms, physical examination findings, vital signs, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic treatment used. All the patients had radical surgical debridement. The FGSI, which was developed to assign a numerical score that describes the acuity of the disease, was used in our study. This index presents patients' vital signs (temperature, heart and respiratory rates) and metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, hematocrit, white blood cell count) and computes a score relating to the severity of the disease at that time. The data were assessed according to whether the patient survived or died.

RESULTS: Of the evaluated 20 patients, 6 died (30%) and 14 survived (70%). The difference in age between survivors (median age, 60.0 yr) and those who died (median age, 64.5 yr) was not significant (p = 0.321). The median extent of the body surface area involved in the necrotizing process in patients who survived and did not survive was 2.3% and 4.8%, respectively (p = 0.001). Except for the albumin and alkaline phosphatase levels, no significant differences were found between survivors and who those died in the other admission laboratory parameters. The median admission FGSI scores for survivors and nonsurvivors were 2.0+/-2.2 and 4.0+/-3.7, respectively (p = 0.331).

CONCLUSIONS: The FGSI score did not predict the disease severity and the patient's survival. Metabolic parameters, predisposing factors, and extent of the disease seemed to be important risk factors for predicting FG severity and whether or not a patient survived.

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