Fournier's Gangrene Severity Index and Charlson Comorbidity Index Predict Mortality, Intensive Care Unit Admission, and Length of Hospital Stay in Patients With Fournier's Gangrene: An Analysis of 264 Consecutive Patients

Abstract

Introduction Fournier's gangrene (FG) is a rapidly progressing necrotizing fasciitis. The Fournier's Gangrene Severity Index (FGSI), in conjunction with the Charlson Comorbidity Index (CCI), has been used as a mortality predictor during hospitalization. Patients with diabetes have also been shown to be at an increased risk for the development of FG. This study explores the potential of using FGSI, CCI, and patient diabetes status in predicting more extensive patient outcomes, including intensive care unit (ICU) admission and length of hospital stay. Methods From 2013 to 2023, inpatient admissions with the diagnosis of FG were selected from the EPIC Clarity database of the Sisters of St. Mary hospital system. Patient demographics, ICU admission, length of hospital stay, medical comorbidities, and calculated FGSI and CCI scores were extracted from selected admissions. Logistic regression and generalized linear regression models were performed for regression analysis. Results A total of 264 patients who met our inclusion criteria were admitted for FG from 2013 to 2023. The patient population was all male with a mean age of 54.7 years. Of the cohort, 127 patients (48.1%) required ICU care, and 44 patients (16.7%) died during admission. Of the 164 patients (62.1%) diagnosed with diabetes, 13 were taking sodium-glucose cotransporter 2 (SGLT-2) inhibitors prior to admission, and 121 were insulin-dependent. No relationship could be found between the use of SGLT-2 inhibitors or insulin and patient outcome. For every one-unit increase in FGSI score, the odds of mortality increased by 1.14 times, the odds of being admitted to the ICU increased by 1.3 times, and the length of hospital stay increased by 1.1 days (p<0.0001). For every one-unit increase in CCI score, the odds of mortality increase by 1.2 times (p=0.003), and the length of hospital stay increased by 0.9 days (p=0.04). Conclusions Insulin-dependent diabetes and the use of SGLT-2 inhibitors are not risk factors for more severe FG. FGSI and CCI scores may be used to predict patient outcomes beyond mortality, including ICU admission and length of hospital stay.

Keywords: charlson comorbidity index; fournier gangrene; fournier gangrene severity index; necrotizing fasciitis; urology.