Evaluation and validation of Fournier gangrene severity index and additional mortality related risk factors in patients with Fournier's gangrene in tertiary care setup in Haryana

Introduction: This study is performed to validate Fournier's gangrene severity index and evaluate the risk factors for predicting mortality in patients with Fournier's Gangrene and to evaluate the validity of FGSI scoring system in predicting mortality in FG patients as well as to evaluate additional risk factors/ parameters for predicting mortality in patient with FG.Materials and Methods: This is a prospective observational study conducted in tertiary care hospital in Gurugram, Haryana under FMHS SGT HOSPITAL over the period of 18 months from January 2021 to Aug 2022. A total of 90 IPD patients with diagnosis of FG fulfilling the inclusion criteria were included in the study and divided in 2 groups of survivor and no survivor, to evaluate the validity of FGSI scoring system in predicting mortality in FG patients and additional risk factors/ parameters for predicting mortality in patient with FG.Results: Out of all, 66 patients survived (73.33%), while 24 died (26.66%).The mean FGSI score was 4.67-3.44SD in patients who survived, and it was 9.82±5.20SD in patients who died. The difference in the mean FGSI score was found to be statistically significant by test (p=0.001) with higher scores among non-survivors. FGSI score of 9 or more 9 is associated with increased mortality which is highly statistically significant (p-value <0> Conclusion: Fournier’s gangrene has high mortality rate in elderly patients with comorbidities. Pain and swelling of genitalia are the two commonest presenting symptoms. Blackish discoloration, and ulceration with discharge are seen in patients presenting late. Disease is idiopathic in majority of patients. Common identifiable causes are ischiorectal/gluteal abscess, urogenital trauma, urinary tract infections and anorectal surgeries. Most common portal of entry of infection is penoscrotal. Anorectal and urogenital route and cutaneous route are other routes in decreasing order of frequency. FGSI is a valid tool for prognosis with increased risk of mortality at score more than 9 with a diagnostic accuracy of 83.3%.