Comparing Scoring Systems and Biomarkers For Mortality in Fournier Gangrene Patients

Abstract Objective We aimed to compare scoring systems and peripheral inflammatory biomarkers in estimating mortality among Fournier's gangrene (FG) patients. Background Multiple scoring systems and biomarkers are utilized to assess FG severity and predict mortality. However, these indices have complexities, limitations, and inconsistencies. Therefore, alternative methods and parameters are investigated. Materials and Methods Each patient’s clinical and laboratory data are well documented at hospitalization, Fournier's gangrene severity index (FGSI), Uludag FGSI (UFGSI), simplified FGSI (SFGSI), and age-adjusted Charlson comorbidity index (ACCI) scores and peripheral blood parameters and ratios were calculated. Patients were compared in two groups as deceased and survived ones. Results Among the 160 patients, 35 (21.9%) died. Diabetes was the most prevalent comorbidity. Deceased patients had significantly higher FGSI, UFGSI, ACCI, and SFGSI scores compared to the survivors ( p < 0.001). Among the prognostic parameters, only the red cell distribution width (RDW) value was statistically significantly higher in the non-surviving group ( p < 0.05). Multivariate analysis identified age, elevated blood urea nitrogen, symptom duration, disease extent, and malignancy as independent prognostic factors. Conclusion FGSI, UFGSI, SFGSI, and ACCI are reliable prognostic scores in FG and aren’t superior to each other. Age, blood urea nitrogen levels, duration of symptoms, disease extent, and coexisting malignancy were found to be independent prognostic factors. Given its rapid and cost-effective nature, RDW should be considered alongside other established parameters in future prognostic models. A new scoring method that includes these variables would be practical and worth testing.