Predictive factors of mortality in Fournier's gangrene.

BACKGROUND: Fournier's Gangrene is a rare but serious condition accounting for a high death rate. Several predictive factors of mortality have been reported from retrospective series but more often these factors vary from one study to another. AIM: The aim of this work is to assess the clinical and therapeutic characteristics of patients treated for Fournier's gangrene in order to determine the predictive factors of mortality.
METHODS: The study enrolled retrospectively all patients admitted in the surgery 'B' unit of Charles Nicolle hospital for Fournier's gangrene during the period ranging between January, 1st, 2000 and December, 31st, 2010. The diagnosis of Fournier's gangrene has been retained each time a tissue necrosis has been noted in perineum, whether during physical examination or intraoperatively. For all patients, clinical variables and treatments were collected. A comparative study was carried out between the group of survivors and deceased.
RESULTS: Forty one patients have been included. The univariate analysis identified the following predictive factors of mortality: extension of lesions outside the perineum (p=0,002), severe sepsis and/or a septic shock (p=0,006), heart rate greater than 90/min (p=0,001), white blood cell count higher than 20000/mm3 (p=0,043) and urea level higher than 7 mmol/l (p=0,009). The multivariate analysis retained the extension of gangrene beyond the perineum as an independent predictive factor of mortality (p=0,004).
CONCLUSION: Improving prognosis of Fournier's gangrene requires early diagnosis ahead of the extension of lesions beside the perineum which is associated with a higher mortality risk despite optimal care and treatment.