Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;41(10):2751-2757.
doi: 10.1007/s00345-023-04552-3. Epub 2023 Aug 14.

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

Yufi Aulia Azmi #  1   2 , Firas F Alkaff #  3   4 , Johan Renaldo  5 , Soetojo Wirjopranoto  6 , Rinta Prasetiyanti  7 , Kevin Muliawan Soetanto  8 , Sovia Salamah  9   10 , Abdul Khairul Rizki Purba #  11   12 , Maarten J Postma #  11   13   14   15
Affiliations

Comparison of different scoring systems for predicting in-hospital mortality for patients with Fournier gangrene

Yufi Aulia Azmi et al. World J Urol. 2023 Oct.

Abstract

Purpose: To compare different scoring systems for predicting in-hospital mortality in patients with Fournier gangrene (FG).

Methods: A comprehensive literature search was performed to find all scoring systems that have been proposed previously as a predictor for in-hospital mortality in patients with FG. Data of all patients with FG who were hospitalized in one of Indonesia's largest tertiary referral hospitals between 2012 and 2022 were used. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the scoring systems.

Results: Ten scoring systems were found, i.e., Fournier's Gangrene Severity Index (FGSI), Uludag FGSI, simplified FGSI, NUMUNE Fournier score (NFS), Laboratory Risk Indicator for Necrotizing Fasciitis, age-adjusted Charlson comorbidity index, sequential organ failure assessment (SOFA), quick SOFA, acute physiology and chronic health evaluation II, and surgery APGAR score (SAS). Of 164 FG patients included in the analyses, 26.4% died during hospitalization. All scoring systems except SAS could predict in-hospital mortality of patients with FG. Three scoring systems had areas under the ROC curve (AUROC) higher than 0.8, i.e., FGSI (AUROC 0.905, 95% confidence interval (CI) 0.860-0.950), SOFA (AUROC 0.830, 95% CI 0.815-0.921), and NFS (AUROC 0.823, 95% CI 0.739-0.906). Both FGSI and SOFA had sensitivity and NPV of 1.0, whereas NFS had a sensitivity of 0.74 and an NPV of 0.91.

Conclusion: This study shows that FGSI and SOFA are the most reliable scoring systems to predict in-hospital mortality in FG, as indicated by the high AUROC and perfect sensitivity and NPV.

Keywords: Diagnosis; Fournier gangrene; Hospital mortality; Indonesia; Infectious disease.

PubMed Disclaimer

Conflict of interest statement

MJP received grants and honoraria from various pharmaceutical companies, all fully unrelated to this research. Other authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Area under the receiver operating characteristic curves (AUROC) of different scoring systems for predicting in-hospital mortality in patients with FG. A Fournier gangrene severity index (FGSI), B Uludag FGSI, C simplified FGSI, D NUMUNE Fournier score, E laboratory risk indicator for necrotizing fasciitis, F age-adjusted Charlson comorbidity index, G sequential organ failure assessment (SOFA), H quick SOFA, I acute physiology and chronic health evaluation II, and J surgery APGAR score
See this image and copyright information in PMC

References

    1. Tosun Y, Akıncı O, Küçük HF. Risk factors for mortality in Fournier’s gangrene of anorectal origin. Ulusal Travma Acil Cerrahi Derg. 2022;28(8):1128–1133. doi: 10.14744/tjtes.2021.97866. - DOI - PMC - PubMed
    1. Taken K, Oncu MR, Ergun M, Eryilmaz R, Demir CY, Demir M, Gunes M. Fournier’s gangrene: causes, presentation and survival of sixty-five patients. Pak J Med Sci. 2016;32(3):746–750. doi: 10.12669/pjms.323.9798. - DOI - PMC - PubMed
    1. Saber A. A simplified prognostic scoring system for Fournier’s gangrene. Urol Nephrol Open Access J. 2014;1(3):79–82. doi: 10.15406/unoaj.2014.01.00018. - DOI
    1. Noegroho BS, Adi K, Mustafa A, Haq RS, Wijayanti Z, Liarto J. 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. 2021;10(2):201–207. doi: 10.1016/j.ajur.2021.11.003. - DOI - PMC - PubMed
    1. Sorensen MD, Krieger JN. Fournier’s gangrene: epidemiology and outcomes in the general US population. Urol Int. 2016;97(3):249–259. doi: 10.1159/000445695. - DOI - PubMed

LinkOut - more resources