Fournier's Gangrene: A Modern Analysis of Predictors of Outcomes

Jeffrey D. Sparenborg; Jacob A. Brems; Andrew M. Wood; Jonathan J. Hwang; Krishnan Venkatesan


Transl Androl Urol. 2019;8(4):374-378. 

In This Article


Of the 42 patients with confirmed FG, 3 patients died during the original admission (7.5%), and 39 survived until discharge (92.5%). Mean patient age was 53 years old, and mean LOS was 19.6 days. FGSI scores ranged from 1 to 13. All patients were treated at MedStar Washington Hospital Center, and underwent an average of 3.2 surgical procedures prior to discharge. Etiologies of FG were varied and included scrotal cellulitis, scrotal abscess, perirectal/perianal abscess, persistent urethral catheterization, hidradenitis, infected Bartholin cyst, and decubitus ulceration.

Documented comorbidities included mellitus (DM), HIV, alcohol abuse, iv drug abuse, coronary artery disease, peripheral vascular disease, chronic kidney disease, obesity, neurologic disease, hypertension, chronic obstructive pulmonary disease (COPD), congestive heart failure, malignancy, and immunosuppression.

The average number of patient comorbidities at presentation was 2.76, with the most common condition being Diabetes, which occurred in 24 of 42 (57.1%) of patients. The number of comorbidities was not associated with patient mortality.

FGSI was calculated for 38 of the 42 patients. The average FGSI score was 5.2. Patients that died had an average FGSI of 10.0, where patients who survived had a mean FGSI score of 5.0. Logarithmic regression analysis showed the relationship between FGSI and mortality was statistically significant, with a Pearson correlation coefficient of 1.63 (CI: 1.04–2.49, P=0.0313) for each interval increase in FGSI score. ROC analysis showed a strong association between FGSI score and patient mortality, with area under the ROC curve equal to 0.8333 (Figure 1). There was a statistically significant relationship between FGSI and length of hospital stay (R=0.40, P=0.0121). FGSI score showed no significant relationship to number of comorbidities or to number of surgical procedures.

Figure 1.

ROC analysis demonstrating the strong association between FGSI score and patient mortality. Area under the ROC curve equal to 0.8333. ROC, receiver operating characteristic; FGSI, Fournier's Gangrene Severity Index.

In addition to the association of comorbidities and FGSI to mortality, we measured the association between FGSI and each of its nine individual components (Table 2). There was a statistically significant association between FGSI and 4 of its 9 variables: Creatinine (R=0.66), Bicarbonate (R=−0.63), white blood cell (WBC) count (R=0.53), and Potassium (R=0.33). There was also a strong relationship between blood urea nitrogen (BUN) (not part of the FGSI score) and FGSI, with R=0.72. Increases in 5 of the 9 constituent variables were not associated with increases in FGSI.