Lesion Length as a Prognosis Marker of Mortality in Patients with Fournier's Gangrene: Proposal of a New Scoring System.

Objective: To assess the prognostic value of mortality of a new system for quantifying the lesion length circumscribed to the genitals and adjacent anatomical areas in patients with Fournier's gangrene.

Methods: An observational, analytical and prospective study in the Urology service of the Arnaldo Milián Castro University Hospital, between January 2007 and December 2019. The sample consisted of 60 patients diagnosed with Fournier's gangrene. To determine the lesion length, a new quantification system was designed by the authors. Its predictive capacity was determined by binary logistic regression analysis and its discriminatory capacity by the area under the ROC curve.

Results: In the studied sample, Fournier's gangrene mortality was 26.7%. The logistic regression analysis demonstrated the prognostic value of mortality of the quantification system evaluated, for each point that the extension of the lesion increased, the risk of death increased by approximately five times, thus being superior to the methods previously used to quantify the injury. Results of the calibration of the quantification system by the Hosmer-Lemeshhow test showed that the data were adjusted to the regression equation ( = 0.278). An area under the curve of 0.957 was observed, which reflects a good discriminatory capacity, showing a sensitivity of 93.75% and a specificity of 93.18%.

Conclusions: The system for quantifying the lesion length in patients with Fournier's gangrene proposed in the present study showed an excellent prognostic value for mortality. The integration of this new method into others prognostic scores could substantially increase sensibility and specificity on diagnostic, by means of offering a more precise approach of the lesion dimensions.