Fournier’s Gangrene: validation of the severity index

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Published Feb 5, 2022
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Vol. 100 No. 2 (2022): Issue feb 2022

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Ahmed Itaimi
Wissem Triki
Imed Abbassi
Karim Ayed
Oussama Baraket
Sami Bouchoucha

Abstract

Introduction: Fournier’s gangrene is a serious infection and is considered a major emergency. A complete assessment of the severity factors
using a severity score is essential and makes it possible to adapt the therapeutic management.

Aim: Validate Fournier’s Gangrene Severity Index and evaluate its benefits in the initial assessment of disease severity.

Methods: This is a retrospective, monocentric study which gathered all the cases of perineal gangrene that were managed in General Surgery
Department of Habib Bougatfa Hospital in Bizerte over a period of 8 years. The primary endpoint in our study was mortality.

Results: Thirty-five cases of Fournier’s gangrene were collected. The average age of our patients was 46 years. Mortality rate was 23%. We
calculated the Fournier’s Gangrene Severity Index for 22 patients. There was a significant difference in the average Fournier’s Gangrene
Severity Index score between the group of surviving patients (3.75) and the group of deceased patients (12.63) (p <0.0001). Using an Fournier’s
Gangrene Severity Index cut-off value> 9.5 (sensitivity 87.5%, specificity 100%), we noted that the mortality rate was significantly higher in the
group with a score> 10 (100%) than in the group with a score ≤ 9 (6%) (p <0.0001). A score greater than 10 was associated with 100% mortality
in our series.

Conclusions: The Fournier’s Gangrene Severity Index, calculated from clinical and biological data, offers a simple, reliable and valid tool to
assess the initial severity of the disease.

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References

  1. Korkut M, Icoz G, Dayangac M, Akgun E, Yeniay L, Erdoğan O, et al. Outcome analysis in patients with Fournier’s gangrene: report of 45 cases. Dis Colon Rectum. 2003;46:649-52.
  2. Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier’s gangrene. J Urol. 1995;154:89-92
  3. Arvieux C, Reche F. Traitement chirurgical des gangrenes du perinee. Encycl Med Chir. (Elsevier Masson, Paris), Techniques chirurgicales – Appareil digestif, 40-695,2011.
  4. Czymek R, Hildebrand P, Kleemann M, Roblick U, Hoffmann M, Jungbluth T, et al. New insights into the epidemiology and etiology of Fournier’s gangrene: a review of 33 patients. Infection. 2009;37:306-12.
  5. S.M. Moudouni , S. Arza*, A. Benhaddou , K.H. Baka. Interet de l’index de severite de la gangrene deFournier dans la prediction des facteurspronostiques de la mortalite. African Journal of Urology. 2017, 347-351-4
  6. Lin T-Y, Ou C-H, Tzai T-S, Tong Y-C, Chang C-C, Cheng H-L, et al. Validation and simplification of Fournier’s gangrene severity index. Int J Urol. 2014;21:696-701.
  7. Tenorio CEL, Lima SVC, Albuquerque AV de, Cavalcanti MP, Teles F. Risk factors for mortality in fournier’s gangrene in a general hospital: use of simplified founier gangrene severe index score (SFGSI). Int Braz J Urol. 2018;44:95-101.
  8. Yilmazlar T, Ozturk E, Ozguc H, Ercan I, Vuruskan H, Oktay B. Fournier’s gangrene: an analysis of 80 patients and a novel scoring system. Tech Coloproctology. 2010;14:217-23.
  9. Arora A, Rege S, Surpam S, Gothwal K, Narwade A. Predicting Mortality in Fournier Gangrene and Validating the Fournier Gangrene Severity Index: Our Experience with 50 Patients in a Tertiary Care Center in India. Urol Int. 2019;1-8.
  10. Kabay S, Yucel M, Yaylak F, Algin MC, Hacioglu A, Kabay B, et al. The clinical features of Fournier’s gangrene and the predictivity of the Fournier’s Gangrene Severity Index on the outcomes. Int Urol Nephrol. 2008;40:997-1004.
  11. Yim SU, Kim SW, Ahn JH, Cho YH, Chung H, Hwang EC, et al. Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios Are More Effective than the Fournier’s Gangrene Severity Index for Predicting Poor Prognosis in Fournier’s Gangrene. Surg Infect. 2016;17:217-23.
  12. Lujan Marco S, Budia A, Di Capua C, Broseta E, Jimenez Cruz F. Evaluation of a severity score to predict the prognosis of Fournier’s gangrene. BJU Int. 2010;106:373-6.
  13. Benjelloun EB, Souiki T, Yakla N, Ousadden A, Mazaz K, Louchi A, et al. Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality. World J Emerg Surg. 2013;8:13.
  14. Sarvestani AS, Zamiri M, Sabouri M. Prognostic Factors for Fournier’s Gangrene; A 10-year Experience in Southeastern Iran. Bull Emerg Trauma. 2013;1:116-22.
  15. Erdoğan A, Aydoğan I, Şenol K, Uckan EM, Ersoz Ş, Tez M. Simple scoring system for prediction of mortality in Fournier’s gangrene. Eur J Trauma Emerg Surg. 2016;42:513-8.
  16. Corcoran AT, Smaldone MC, Gibbons EP, Walsh TJ, Davies BJ. Validation of the Fournier’s gangrene severity index in a large contemporary series. J Urol. 2008;180:944-8.
  17. Dahm P, Roland FH, Vaslef SN, Moon RE, Price DT, Georgiade GS, et al. Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia. Urology. 2000;56:31-5.
  18. Olsofka JN, Carrillo EH, Spain DA, Polk HC. The continuing challenge of Fournier’s gangrene in the 1990s. Am Surg. 1999;65:1156-9.