Fournier's gangrene mortality: peri-umbilical cutaneous involvement as a crucial clinical indicator

Fournier's gangrene (FG) is a severe urological emergency characterized by high mortality and requiring intensive management. Our objective was to ascertain the clinical and biological determinants of mortality in cases of FG, assessed one month following the initial surgical intervention.

We conducted a retrospective study of male patients treated surgically for urologically-originating Fournier's gangrene, diagnosed through physical examination, from January 2002 to December 2022. We analyzed clinical predictors by dividing affected skin into nine zones: scrotal, penile, perineal, hypogastric, right inguinal, left inguinal, right flank, left flank, and peri-umbilical regions.

Our study included 118 patients, average age 58.97 years (± 13.84). Among them, 60.2% had diabetes, 27.1% were hypertensive, and 51.7% had a performance status of ≥ 2. At admission, 70% had a quick SOFA score of 0. The one-month postoperative mortality rate was 12.7%. In univariate analysis, all predefined cutaneous areas were significant except the scrotal region, with higher odds ratios for upper abdominal involvement. Independent predictive factors for one-month postoperative mortality were a heart rate ≥ 89 bpm (p = 0.001; OR = 6.96; 95% CI 2.16–22.40), systolic blood pressure ≤ 115 mmHg (p = 0.009; OR = 4.24; 95% CI 1.34–13.41), and peri-umbilical involvement (p < 0.001; OR = 216.67; 95% CI 33.06–1420.20). Peri-umbilical involvement had a notably stronger predictive effect on one-month postoperative mortality.

Fournier's gangrene prognosis worsens with more abdominal skin involvement. Key factors for one-month postoperative mortality are heart rate ≥ 89 bpm, systolic blood pressure ≤ 115 mmHg, and peri-umbilical involvement, which is notably linked to higher mortality.