Prediction of Mortality in Patients with Fournier's Gangrene: Importance of Time to Surgery

Purpose To evaluate the clinical and laboratory findings that predict mortality,the role of five scoring systems in mortality prediction,and the importance of the time from admission to emergency department to surgery in Fournier’s Gangrene(FG) patients. Methods A total of 354 patients who were diagnosed with FG were divided into survivors (n = 293) and non-survivors (n = 61).Multivariate logistic regression analysis was applied for variables that were statistically significant in the univariate analysis regarding factors predicting mortality in patients with FG.Fournier Gangrene Severity Index(FGSI) score,Uludağ Fournier Gangrene Severity Index(UFGSI) score,Age-adjusted Charlson Comorbidity Index(ACCI),Laboratory risk indicator for necrotizing fasciitis(LRINEC) index and The Combined Urology and Plastics Index(CUPI) were analyzed with receiver operating characteristic(ROC) curve for the predicting the mortality of FG. Results The mortality rate due to FG was found to be 17.2%.Advanced age,increased respiratory rate,high serum chloride,low serum bicarbonate,low serum albumin,and the time between hospital admission and surgery are independent predictors of FG mortality in the multivariate analysis.The area under ROC curve (AUC) values of FGSI score,UFGSI score,ACCI,LRINEC index,CUPI were found to be 0.719,0.751,0.641,0.636,0.751,respectively.Mortality was 13.3% in patients with a time of up to 12 hours until surgery,and 24.2% in patients with a time of more than 12 hours until surgery.Also,a time to surgery longer than 12 hours was associated with longer length of hospital stay (p = 0.001). Conclusions If a scoring system is to be used for FG-related mortality,the UFGSI score and CUPI should be evaluated primarily.One of the most important aspects of reducing mortality is complete debridement within 12 hours of hospital admission.