Predictive Factors for Mortality in Fournier's Gangrene: A Series of 59 Cases

AimsFournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area and presents a high mortality rate. The aim was to assess prognostic factors for mortality, create a new mortality predictive scale and compare it with previously published scales in patients diagnosed with FG in our Emergency Department.MethodsRetrospective analysis study between 1998 and 2012.ResultsOf the 59 patients, 44 survived (74%) (S) and 15 died (26%) (D). Significant differences were found in peripheral vasculopathy (S 5 [11%]; D 6 [40%]; P = .023), haemoglobin (S 13; D 11; P = .014), haematocrit (S 37; D 31.4; P = .009), white blood cells (S 17,400; D 23,800; P = .023), serum urea (S 58; D 102; P = .001), creatinine (S 1.1; D 1.9; P = .032), potassium (S 3.7; D 4.4; P = .012) and alkaline phosphatase (S 92; D 133; P = .014). Predictive scores were: Charlson index (S 1; D 4; P = .013), severe sepsis criteria (S 16 [36%]; D 13 [86%]; P = .001), Fournier's Gangrene Severity Index Score (FGSIS) (S 4; D 7; P = .002) and Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; D 13; P = .004). Independent predictive factors were peripheral vasculopathy, serum potassium and severe sepsis criteria, and a model was created with an area under the ROC curve of 0.850 (0.760–0.973), higher than FGSIS (0.746 [0.601–0.981]) and UFGSI (0.760 [0.617–0.904]).ConclusionsFG showed a high mortality rate. Independent predictive factors were peripheral vasculopathy, potassium and severe sepsis criteria creating a predictive model that performed better than those previously described.

ResumenObjetivosLa gangrena de Fournier (GF) es la fascitis necrosante del periné y área genital que presenta una elevada mortalidad. El objetivo es analizar los factores pronósticos de mortalidad, creación de una nueva escala predictiva de mortalidad y compararla con las ya validadas en los pacientes diagnosticados de GF en nuestro Servicio de Urgencias.MétodosEstudio analítico, retrospectivo entre 1998 y 2012.ResultadosDe los 59 casos, 44 sobrevivieron (74%) (S) y 15 fallecieron (26%) (E). Se encontraron diferencias significativas en la vasculopatía periférica (S 5 [11%]; E 6 [40%]; p = 0,023), haemoglobin (S 13; E 11; p = 0,014), haematocrito (S 37; E 31,4; p = 0,009), leucocitos (S 17.400; E 23.800; p = 0,023), urea (S 58; E 102; p < 0,001), creatinina (S 1,1; E 1,9; p = 0,032), potasio (S 3,7; E 4,4; p = 0,012) y fosfatasa alcalina (S 92; E 133; p = 0,014). Escalas predictivas: índice de Charlson (S 1; E 4; p = 0,013), criterios de sepsis grave (S 16 [36%]; E 13 [86%]; p = 0,001), Fournier's gangrene severity index score (FGSIS) (S 4; E 7; p = 0,002) y Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; E 13; p = 0,004). Los factores predictores independientes fueron la vasculopatía periférica, el potasio sérico y criterios de sepsis grave, creando un modelo con área bajo la curva de 0,850 (0,760-0,973) superior al FGSIS (0,746 [0,601-0,981]) y al UFGSI (0,760 [0,617-0,904]).ConclusionesLa GF presentó una tasa de mortalidad elevada cuyos factores predictores independientes fueron la vasculopatía periférica, el potasio sérico y criterios de sepsis grave, creando un modelo con una capacidad discriminativa superior al resto.