Prognostic determinants and treatment outcomes of Fournier’s Gangrene treatment in a resource-limited setting: A retrospective study
Accepted: June 8, 2023
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background: Fournier’s gangrene (FG) is a destructive necrotizing infection with a generally poor prognosis. This study aims to share our experience in handling FG patients in a resource-limited setting and identify prognostic factors for FG mortality. Methods: A retrospective study of thirty-six patients diagnosed with FG and treated at our teaching hospital between Jun 2010 to Oct 2022 was conducted. Laboratory and nonlaboratory data and patients' outcomes were gathered. A univariate analysis was computed for identifying prognostic factors for FG mortality. Result: The main age was 68.30 ± 5.61years and most (69.4%) were older than 65 years. The overall survival was 63.9% and the mortality rate was 36.1%. Univariate analysis showed that advanced age (p = 0.02), delayed in hospital presentation (p = 0.024), involvement of larger area (p = 0.001), a history of diabetes mellitus (p < 0.006), end-stage renal disease (p = 0.018), heart failure (p = 0.005), cerebrovascular accident (p = 0.003), liver cirrhosis (p = 0.001), presence of multiple comorbidities (p = 0.001), septic conditions at admission (p = 0.048), need for mechanical ventilation (p = 0.001), hypoalbuminemia (p < 0.001), and elevated blood urea nitrogen (p = 0.002) were found to be risk factors for mortality in patients with FG. Conclusions: Fournier’s gangrene is a fulminant condition with a high mortality rate, especially in resource-limited settings. In this study, the mortality rate was 36.1%. Advanced age, delayed in hospital presentation, involvement of larger area, a history of diabetes mellitus, end-stage renal disease, heart failure, cerebrovascular accident, liver cirrhosis, presence of multiple comorbidities, septic conditions at admission, need for mechanical ventilation, hypoalbuminemia, and elevated blood urea nitrogen were associated with FG mortality.
Boughanmi F, Ennaceur F, Korbi I, et al. Fournier's gangrene: its management remains a challenge. Pan Afr Med J. 2021; 38:23. DOI: https://doi.org/10.11604/pamj.2021.38.23.25863
Thwaini A, Khan A, Malik A, et al. Fournier's gangrene and its emergency management. Postgrad Med J. 2006; 82:516-519. DOI: https://doi.org/10.1136/pgmj.2005.042069
Tuncel A, Aydin O, Tekdogan U, et al. Fournier's gangrene: Three years of experience with 20 patients and validity of the Fournier's Gangrene Severity Index Score. Eur Urol. 2006; 50:838-843. DOI: https://doi.org/10.1016/j.eururo.2006.01.030
Zhang KF, Shi CX, Chen SY, et al. Progress in Multidisciplinary Treatment of Fournier's Gangrene. Infect Drug Resist. 2022; 15:6869-6880. DOI: https://doi.org/10.2147/IDR.S390008
Hong KS, Yi HJ, Lee RA, et al. Prognostic factors and treatment outcomes for patients with Fournier's gangrene: a retrospective study. Int Wound J. 2017; 14:1352-1358. DOI: https://doi.org/10.1111/iwj.12812
Noegroho BS, Adi K, Mustafa A, et al. The role of quick Sepsis-related Organ Failure Assessment score as simple scoring system to predict Fournier gangrene mortality and the correlation with Fournier's Gangrene Severity Index: Analysis of 69 patients. Asian J Urol. 2023; 10:201-207. DOI: https://doi.org/10.1016/j.ajur.2021.11.003
Al-Kohlany K, Baker K, Ahmed F, et al. Treatment outcome of Fournier's gangrene and its associated factors: A retrospective study. Arch Ital Urol Androl. 2023:11318. DOI: https://doi.org/10.4081/aiua.2023.11318
Doluoglu Ö G, Karagöz MA, Kılınç MF, et al. Overview of different scoring systems in Fournier's Gangrene and assessment of prognostic factors. Turk J Urol. 2016; 42:190-196. DOI: https://doi.org/10.5152/tud.2016.14194
Feres O, Feitosa MR, Ribeiro da Rocha JJ, et al. Hyperbaric oxygen therapy decreases mortality due to Fournier's gangrene: a retrospective comparative study. Med Gas Res. 2021; 11:18-23. DOI: https://doi.org/10.4103/2045-9912.310055
Griebling TL. Re: Prognostic Factors of Fournier's Gangrene in the Elderly: Experiences of a Medical Center in Southern Taiwan. J Urol. 2017; 197:709. DOI: https://doi.org/10.1016/j.juro.2016.12.052
Huang CS. Fournier's Gangrene. N Engl J Med. 2017; 376:1158. DOI: https://doi.org/10.1056/NEJMicm1609306
Sabzi Sarvestani A, Zamiri M, Sabouri M. Prognostic Factors for Fournier's Gangrene; A 10-year Experience in Southeastern Iran. Bull Emerg Trauma. 2013; 1:116-122.
Tahmaz L, Erdemir F, Kibar Y, et al. Fournier's gangrene: report of thirty-three cases and a review of the literature. Int J Urol. 2006; 13:960-967. DOI: https://doi.org/10.1111/j.1442-2042.2006.01448.x
El-Qushayri AE, Khalaf KM, Dahy A, et al. Fournier's gangrene mortality: A 17-year systematic review and meta-analysis. Int J Infect Dis. 2020; 92:218-225. DOI: https://doi.org/10.1016/j.ijid.2019.12.030
Tuncel A, Keten T, Aslan Y, et al. Comparison of different scoring systems for outcome prediction in patients with Fournier's gangrene: experience with 50 patients. Scand J Urol. 2014; 48:393-399. DOI: https://doi.org/10.3109/21681805.2014.886289
Martinschek A, Evers B, Lampl L, et al. Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier's gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients. Urol Int. 2012; 89:173-179. DOI: https://doi.org/10.1159/000339161
Yeniyol CO, Suelozgen T, Arslan M, et al. Fournier's gangrene: experience with 25 patients and use of Fournier's gangrene severity index score. Urology. 2004; 64:218-222. DOI: https://doi.org/10.1016/j.urology.2004.03.049
Wetterauer C, Ebbing J, Halla A, et al. A contemporary case series of Fournier's gangrene at a Swiss tertiary care center-can scoring systems accurately predict mortality and morbidity? World J Emerg Surg. 2018; 13:25. DOI: https://doi.org/10.1186/s13017-018-0187-0
Chalya PL, Igenge JZ, Mabula JB, et al. Fournier's gangrene at a tertiary health facility in northwestern Tanzania: a single centre experiences with 84 patients. BMC Res Notes. 2015; 8:481. DOI: https://doi.org/10.1186/s13104-015-1493-1
Sallami S, Maalla R, Gammoudi A, et al. Fournier's gangrene : what are the prognostic factors? Our experience with 40 patients. Tunis Med. 2012; 90:708-714.
Dahm P, Roland FH, Vaslef SN, et al. Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia. Urology. 2000; 56:31-35. DOI: https://doi.org/10.1016/S0090-4295(00)00604-X
Lewis GD, Majeed M, Olang CA, et al. Fournier's Gangrene Diagnosis and Treatment: A Systematic Review. Cureus. 2021; 13:e18948. DOI: https://doi.org/10.7759/cureus.18948
Roghmann F, von Bodman C, Löppenberg B, et al. Is there a need for the Fournier's gangrene severity index? Comparison of scoring systems for outcome prediction in patients with Fournier's gangrene. BJU Int. 2012; 110:1359-1365. DOI: https://doi.org/10.1111/j.1464-410X.2012.11082.x
Villanueva-Sáenz E, Martínez Hernández-Magro P, Valdés Ovalle M, et al. Experience in management of Fournier's gangrene. Tech Coloproctol. 2002; 6:5-10. DOI: https://doi.org/10.1007/s101510200001
Laor E, Palmer LS, Tolia BM, et al. Outcome prediction in patients with Fournier's gangrene. J Urol. 1995; 154:89-92. DOI: https://doi.org/10.1016/S0022-5347(01)67236-7
Clayton MD, Fowler JE, Jr., Sharifi R, et al. Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. Surg Gynecol Obstet. 1990; 170:49-55.
Sarofim M, Di Re A, Descallar J, et al. Relationship between diversional stoma and mortality rate in Fournier's gangrene: a systematic review and meta-analysis. Langenbecks Arch Surg. 2021; 406:2581-2590. DOI: https://doi.org/10.1007/s00423-021-02175-z
Spirnak JP, Resnick MI, Hampel N, et al. Fournier's gangrene: report of 20 patients. J Urol. 1984; 131:289-291. DOI: https://doi.org/10.1016/S0022-5347(17)50351-1
Auerbach J, Bornstein K, Ramzy M, et al. Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives. Open Access Emerg Med. 2020; 12:353-364. DOI: https://doi.org/10.2147/OAEM.S238699
Benjelloun el B, Souiki T, Yakla N, et al. Fournier's gangrene: our experience with 50 patients and analysis of factors affecting mortality. World J Emerg Surg. 2013; 8:13. DOI: https://doi.org/10.1186/1749-7922-8-13
Yanar H, Taviloglu K, Ertekin C, et al. Fournier's gangrene: risk factors and strategies for management. World J Surg. 2006; 30:1750-1754. DOI: https://doi.org/10.1007/s00268-005-0777-3
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.