Don't waste time with scoring systems to predict mortality in Fournier's Gangrene, regulate blood sugar, and defy death!

Background: Fournier's Gangrene (FG) is a rare, life-threatening necrotizing fasciitis of the perineum and genitourinary regions with high morbidity and mortality rates. Despite advancements in healthcare, FG remains a challenge due to its rapid progression and the need for aggressive intervention. This study aims to investigate the factors influencing mortality in FG patients, assess the effectiveness of laboratory parameters and scoring systems, and emphasize the role of blood glucose regulation in improving survival.

Methods: This retrospective study included 36 patients diagnosed with FG at Bolu Abant İzzet Baysal University Medical Faculty Hospital between January 2014 and September 2024. Patients with incomplete data, a history of isolated perineal, gynecological, or perianal surgeries unrelated to FG, and those under 18 years of age were excluded. For all patients, Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), Lymphocyte-Monocyte Ratio (LMR), CRP-Albumin Ratio (CAR), and Prognostic Nutritional Index (PNI), Inflammatory Prognostic Index (IPI), Systemic Inflammation Index (SII), Urology and Plastics Index (CUPI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), Fournier's Gangrene Severity Index (FGSI), and Uludağ Fournier's Gangrene Severity Index (UFGSI) scores were calculated. A comparison was made between the results obtained from laboratory parameters and scoring systems and the effect of blood sugar regulation on survival. Statistical analyses were performed using SPSS 27.

Results: The mean age of the patients was 64.67±13.25 years, with a male-to-female ratio of 3: 1. Diabetes Mellitus (DM) was present in 61.1% of cases and 66.7% of deceased patients. The mortality rate was 16.7%. Elevated blood glucose levels at admission were significantly associated with mortality (p=0.024). The cut-off value of 186.5 mg/dL for glucose predicted mortality with 83.3% sensitivity and specificity. Scoring systems such as LRINEC and CUPI also demonstrated predictive utility, but glucose was found to be a simpler, faster marker. Among inflammatory markers, Neutrophil-Lymphocyte Ratio (NLR) was significant (p=0.016) with a cut-off of 14.04, showing 83.3% sensitivity and 76.7% specificity.

Conclusion: FG is a rapidly progressing disease requiring early diagnosis and multidisciplinary management. While scoring systems and inflammatory markers are valuable for predicting mortality, blood glucose level stands out as a simple, rapid, and effective predictor. Ensuring blood sugar regulation can significantly improve prognosis and survival in FG patients, underscoring the need for immediate attention to glucose levels in clinical practice.