Novel predictive tool for Fournier gangrene: Twenty-year experience of a tertiary institute

Purpose: This study aimed to identify prognostic factors and provide a novel image classification method for patients with Fournier gangrene. Materials and methods: A total of 40 consecutive patients diagnosed with Fournier gangrene between January 2003 and December 2022 were enrolled. Demographic characteristics, clinical presentations, management strategies, and outcomes were retrospectively analyzed. Results: The overall survival rate was 87.5% (35/40). Diabetic foot history, chronic kidney disease, end-stage renal disease, or peripheral arterial occlusive disease were significantly ( P < 0.05) more common in nonsurvivors than in survivors. Among the parameters of the Fournier’s Gangrene Severity Index, only the initial creatinine level was significantly associated with mortality ( P = 0.02). Nevertheless, the Fournier’s Gangrene Severity Index score with a cutoff score of 9 remained a useful indicator of death ( P = 0.04). Patients with grade II (extensive) invasion determined by whole abdominal computed tomography had significantly higher mortality rates than those with grade I (nonextensive) (37.5% versus 6.3%, P = 0.04). Conclusion: Patients with a history of diabetic foot, chronic kidney disease, end-stage renal disease, and peripheral arterial occlusive disease had a higher risk of death. Early image computed tomography studies are essential for evaluating the risk and extent of the disease. More predictive tools are needed to assess this aggressively infectious disease.