Enhanced prognostic model for mortality in patients with Fournier gangrene: Validation of the Fournier gangrene mortality index and integration of platelet count and PCO₂
American Journal of Emergency Medicine, cilt.100, ss.170-174, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 100
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.ajem.2025.12.004
- Dergi Adı: American Journal of Emergency Medicine
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Health Research Premium Collection (ProQuest)
- Sayfa Sayıları: ss.170-174
- Anahtar Kelimeler: Fournier gangrene, Fournier gangrene mortality index, Platelet count, PCO 2, Prognostic model, In-hospital mortality
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Fournier gangrene is a rapidly progressive necrotizing infection of the perineum and external genitalia with high mortality. Early and accurate risk stratification is essential for guiding timely interventions. The Fournier Gangrene Mortality Index (FGMI) was recently developed to predict mortality; however, external validation and potential refinements remain limited. Objective: To externally validate the FGMI and evaluate whether incorporating platelet count and arterial partial pressure of carbon dioxide (PCO₂) enhances the prediction of in-hospital mortality in patients with Fournier gangrene. Methods: This retrospective observational study included 104 adult patients with Fournier gangrene admitted to a tertiary care center between January 2017 and January 2025. Demographic, clinical, and laboratory data were collected at admission. The primary outcome was in-hospital mortality. Prognostic performance of FGMI, simplified Fournier's Gangrene Severity Index (FGSI), and an augmented FGMI model incorporating platelet count and PCO₂ (FGMI-2P) was assessed using logistic regression and receiver operating characteristic (ROC) curve analysis. Pairwise comparisons of area under the curve (AUC) values were performed using DeLong's test. Results: Seventeen of 104 patients (16.3 %) died during hospitalization. Non-survivors were older and had lower platelet counts, albumin, and PCO₂ levels, as well as higher blood urea nitrogen, INR, and lactate levels compared with survivors. FGMI was independently associated with mortality (odds ratio, 1.89; 95 % confidence interval, 1.34–10.74; p = 0.020). The augmented FGMI-2P model, incorporating platelet count and PCO₂, demonstrated superior discrimination (AUC 0.876; 95 % CI, 0.763–0.990) compared with FGMI (AUC 0.710) and simplified FGSI (AUC 0.666). Pairwise AUC comparisons revealed no statistically significant differences, but FGMI-2P showed the highest sensitivity (77.8 %), specificity (83.0 %) and positive likelihood ratio (4.6) and lowest negative likelihood ratio (0.27). Conclusions: FGMI is a reliable early predictor of mortality in patients with Fournier gangrene. Adding platelet count and arterial PCO₂ to the model (FGMI-2P) improves prognostic accuracy, reflecting underlying coagulopathic and perfusion-related derangements. External validation in larger, multicenter cohorts is warranted to confirm these findings and facilitate broader clinical adoption.