OUTCOME PREDICTION IN PATIENTS WITH FOURNIERS GANGRENE

We treated 30 patients with Fournier's gangrene during a 15-year perio d. Data were collected on demographics, medical history, admission sig ns and symptoms, physical examination, admission laboratory studies an d bacteriology. The timing and degree of surgical debridement as well as antibiotic therapy were also reviewed. The extent of disease was ca lculated from body surface area nomograms. Data were stratified accord ing to the outcomes of death (13 patients) or survival (17). Patients who survived were significantly younger (53 years old, range 23 to 90) than those who died (71 years old, range 53 to 83, p = 0.004). Admiss ion laboratory parameters that were statistically related to outcome i ncluded hematocrit, blood urea nitrogen, calcium, albumin, alkaline ph osphatase and cholesterol levels. White blood count, platelets, potass ium, bicarbonate, blood urea nitrogen, total protein, albumin and lact ic dehydrogenase levels 1 week following hospitalization were also ass ociated with outcome. The greater mean extent of body surface area inv olved among patients who died was not statistically different from tha t of those who lived (7.16 and 4.32%, respectively, p = 0.1). The numb er of surgical debridements did not seem to influence outcome. To asse ss better the physiological profile of the patients in both outcome ca tegories, the acute physiology and chronic health evaluation II severi ty score was modified to create a Fournier's gangrene severity index. The mean Fournier's gangrene severity index for survivors was 6.9 +/- 0.9 compared to 13.5 +/- 1.5 for nonsurvivors. Regression analysis dem onstrated a strong correlation between Fournier's gangrene severity in dex and death rate (correlation coefficient = 0.934, p = 0.005). Using a Fournier's gangrene severity index threshold value of 9, there was a 75% probability of death with a score greater than 9, while a score of 9 or less was associated with a 78% probability of survival (p = 0. 008). In conclusion, Fournier's gangrene is an infectious disease affe cting an ever aging population of patients. Deviation from homeostasis is the most important parameter predictive of outcome and not the ext ent of disease or performance of surgical debridement. The Fournier's gangrene severity index is an objective and simple method to quantify the extent of metabolic aberration that may be used to predict outcome . We recommend the use of the Fournier's gangrene severity index when evaluating therapeutic options and reporting results.