Predictive value of modified severity index for fournier's gangrene

ABSTRACT

Fournier's gangrene is a rare but lethal disease initiating from minor local infection in the perineal viscera in susceptible individuals. It is the synergistic necrotizing fascitis of the genital, urinary and perianal tissues. The objective of this study was to determine if incorporating the skin loss and platelets count increases the predictive value of fournier's gangrene severity index described by Laor et al. This is an analysis of demographics, presentations, concomitant morbidities, management and outcome in 15 patients with fournier's gangrene managed during last fifteen years. Various clinical and para-clinical parameters were scored on the basis of Laor's index. The additional features of surface area and platelets count were also scored for the modified index. Then the relationships of these two indices with survival were evaluated. In this study of 15 patients, the mortality rate was 27%. Regarding Laor's index, the mean score for survived group was 6 with the range of 2 to 10 whereas that for dead group was 11.5 with the range of 8 to 13. There was 67% probability of death for the patients scoring more than "7" whereas the score of "7" or less was associated with 100% probability of survival. Regarding the modified index, the mean score for survived group was 8.5 with the range of 2 to 12 whereas that for dead group was 15 with the range of 14 to 17. There was 100% probability of survival for the patients having score of "12" or less whereas the score of more than "12" was associated with 100% probability of death. The proposed modification of Laor's index appears to be having better predictive value of outcome but needs to be evaluated in trials having statistical significance: