Evaluation of the utility of different scoring systems (FGSI, LRINEC and NLR) in the management of Fournier's gangrene.

PURPOSE: To evaluate the mortality and morbidity prediction capability of three different scoring systems: Fournier's gangrene severity index (FGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and neutrophile-lymphocyte ratio (NLR) with this retrospective cohort study.

METHODS: Medical records of all patients treated for FG with the final histopathological diagnosis between October 2008 and January 2013 were retrospectively evaluated. Data were collected from medical history, physical examination findings, biochemical and microbiological tests and tissue cultures. FGSI and LRINEC scores and NLR were determined for all patients. Then, it was explored whether higher FGSI (<4 vs. ≥4), LRINEC (<6 vs. ≥6) or NLR (<10 vs. ≥10) were associated with worse prognosis.

RESULTS: A total of 33 patients were evaluated; 3 died (9.1 %) and 30 (90.9 %) survived. Mean age was 57.6 ± 13.2 years. Survivors were younger than nonsurvivors (56 ± 12.8 vs. 72.9 ± 7.3, p < 0.05). Diabetes mellitus was the most encountered predisposing factor with 66.7 % prevalence. All patients with localized disease (100 %) and 8/11 patients (72.7 %) with extended disease survived (p < 0.05). Patients with higher FGSI scores, LRINEC scores and NLR were more likely to require mechanical ventilation in intensive care unit and longer hospitalization times and were more likely to die compared to patients with lower scores.

CONCLUSION: In conclusion, all evaluated scoring systems, FGSI, LRINEC and NLR, are capable of pointing out worse prognosis including mechanical ventilation requirement and mortality. NLR has the advantage of its rapid, simple and low-cost characteristics.