Fournier's gangrene is a necrotizing cellulitis of the perineum which can be fatal if not treated early and aggressively. Fournier's gangrene severity index score can be used to predict whether the patient will survive or not.
Findings correlating with prognosis
(1) age (younger tended to do better than older patients)
(2) some laboratory parameters at admission (hematocrit, BUN, calcium, albumin, alkaline phosphatase, cholesterol)
(3) some laboratory parameters one week after admission (white blood cell count, platelet count, potassium, bicarbonate, BUN, total protein, albumin and LDH)
(4) coexistent conditions such as renal failure and hepatic dysfunction (presence of conditions associated with greater mortality rate)
Findings not correlating with prognosis:
(1) number of surgical debridements
(2) body surface area involved (controversial)
|
region |
percent body surface area |
|
penis |
1% |
|
scrotum |
1% |
|
scrotum to coccyx, about midline |
1% |
|
region of left ischial tuberosity |
2.5% |
|
region of right ischial tuberosity |
2.5% |
|
Parameter |
Finding |
Points |
|
temperature in °C |
> 40 |
+4 |
|
|
39 – 40.0 |
+3 |
|
|
38.5 – 38.9 |
+1 |
|
|
36- 38.4 |
0 |
|
|
34- 35.9 |
+1 |
|
|
32- 33.9 |
+2 |
|
|
30- 31.9 |
+3 |
|
|
<= 29.9 |
+4 |
|
heart rate in beats per minute |
>= 180 |
+4 |
|
|
140- 179 |
+3 |
|
|
110- 139 |
+2 |
|
|
70- 109 |
0 |
|
|
55- 69 |
+2 |
|
|
40- 54 |
+3 |
|
|
<= 39 |
+4 |
|
respiratory rate in breaths/minute |
>= 50 |
+4 |
|
|
35- 49 |
+3 |
|
|
25- 34 |
+1 |
|
|
12- 24 |
0 |
|
|
10- 11 |
+1 |
|
|
6 - 9 |
+2 |
|
|
<= 5 |
+4 |
|
serum sodium in mEq/L |
>= 180 |
+4 |
|
|
160- 179 |
+3 |
|
|
155- 159 |
+2 |
|
|
150- 154 |
+1 |
|
|
130- 149 |
0 |
|
|
120- 129 |
+2 |
|
|
111- 119 |
+3 |
|
|
<= 110 |
+4 |
|
serum potassium in mEq/L |
>= 7.0 |
+4 |
|
|
6.0 - 6.9 |
+3 |
|
|
5.5 - 5.9 |
+1 |
|
|
3.5 - 5.4 |
0 |
|
|
3.0 - 3.4 |
+1 |
|
|
2.5 - 2.9 |
+2 |
|
|
< 2.5 |
+4 |
|
serum creatinine in mg/dL |
>= 3.5 |
+4 |
|
|
2- 3.4 |
+3 |
|
|
1.5- 1.9 |
+2 |
|
|
0.6- 1.4 |
0 |
|
|
< 0.6 |
+2 |
|
hematocrit in percent |
>= 60 |
+4 |
|
|
50- 59.9 |
+2 |
|
|
46- 49.9 |
+1 |
|
|
30- 45.9 |
0 |
|
|
20- 20.9 |
+2 |
|
|
< 20 |
+4 |
|
WBC per µL, in thousands |
>= 40 |
+4 |
|
|
20- 39.9 |
+2 |
|
|
15- 19.9 |
+1 |
|
|
3- 14.9 |
0 |
|
|
1- 2.9 |
+2 |
|
|
< 1 |
+4 |
|
venous serum bicarbonate in mEq/L |
>= 52 |
+4 |
|
|
41- 51.9 |
+3 |
|
|
32- 40.9 |
+1 |
|
|
22- 31.9 |
0 |
|
|
18- 21.9 |
+2 |
|
|
15- 17.9 |
+3 |
|
|
< 15 |
+4 |
where:
• sodium, potassium and bicarbonate are in mEq/L = mmol/L
• serum creatinine is in mg/dL; Table 1 (Laor, 1995) is annotated "x2 for acute renal failure", which is unclear but which may indicate that the breakpoint values are double if there is acute renal failure, or else that the points assigned are doubled if there is acute renal failure.
Fournier's gangrene severity index score =
= SUM (values for parameters)
Interpretation:
• minimum score: 0
• maximum score: 36
• scores <= 9: predicted survival 78%
• scores > 9: predicted mortality 75%
Purpose: To use a severity index score to predict the outcome in a male with Fournier's gangrene.
Specialty: Infectious Diseases, Surgery, general
Objective: severity, prognosis, stage
ICD-10: N49.8,
