Fournier’s Gangrene: validation of the severity index

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.