Fournier’s gangrene and factors predicting outcome of clinical management: a retrospective cohort study

Abstract Background Fournier’s gangrene is a rare Urologic emergency with high fatality rate, as high as 88%. It is preponderant in males with a male female ratio of 10:1, diagnosis is clinical, requiring timely and aggressive intervention as this improves clinical outcome. It is pertinent to identify prognostic factors to improve outcome of management. Methods It is a retrospective cohort study. Data of patients managed for Fournier’s gangrene from January 2019 to December 2024 were retrieved from medical records and theatre records. This includes sociodemographic, anthropometry, risk factors, etiological factors, laboratory parameters. Patients with incomplete medical records were excluded from the study. Fournier’s gangrene severity index score was calculated. Data was analyzed using Statistical package for social sciences (SPSS) version 27.0. Categorical data such as age, BMI, ethnicity, level of education was presented in proportion while continuous data were presented in mean with standard deviation. Association between independent and dependent variable were assessed with Fisher’s exact and Pearson chi square where appropriate, means of laboratory parameters was compared with outcome using t-test. Level significance set at p < 0.05. Results The study includes 39 male patients, with mean age of 51.26 ± 14.37, majority of patients were above 60 years, majority (56.4%) had secondary level of education. Using international standard classification of occupation 64.1% had skill level 2, while most of the patient 82.1% belonged to the lower socioeconomic class. A mortality of 16.7% was recorded, Fournier’s gangrene severity score index was statistically significant in predicting outcome of Fournier’s gangrene management, Fishers exact test = 32.416; p < 0.001. Mean Fournier’s gangrene severity index score between survivors and non survivors was 6.06 ± 2.30 and 18.50 ± 3.56 respectively, p < 0.001. AUC ROC with cut-off value of 9.50 in determining outcome of Fournier’s gangrene showed a sensitivity of 100% and specificity of 97.0%. p value < 0.001. Using t-test there was an association between serum bicarbonate and serum total bilirubin in determining outcome of Fournier’s gangrene t = 5.648; 0.579 respectively; p < 0.001. Conclusion The study highlights the sensitivity and specificity of Fournier’s gangrene severity index score in determining outcome of Fournier’s gangrene, it also revealed that there is a statistically significant association between serum bicarbonate and total serum bilirubin in determining severity and outcome of Fournier’s gangrene.