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Original Article

J Liaquat Uni Med Health Sci. 2007; 6(1): 16-20


PREDICTIVE VALUE OF MODIFIED SEVERITY INDEX FOR FOURNIER’S GANGRENE

Abdul Samad.

Abstract
BACKGROUND/OBJECTIVE: Fournier’s gangrene is a rare but lethal disease initiating from minor
local infection in the perineal viscera in susceptible individuals. It is the synergistic necrotizing
fascitis of the genital, urinary and perianal tissues. The objective of this study was to
determine if incorporating the skin loss and platelets count increases the predictive value of
fournier’s gangrene severity index described by Laor et al.
METHODS: This is an analysis of demographics, presentations, concomitant morbidities, management
and outcome in 15 patients with fournier’s gangrene managed during last fifteen years.
Various clinical and para-clinical parameters were scored on the basis of Laor’s index. The additional
features of surface area and platelets count were also scored for the modified index.
Then the relationships of these two indices with survival were evaluated.
RESULTS: In this study of 15 patients, the mortality rate was 27%. Regarding Laor’s index, the
mean score for survived group was 6 with the range of 2 to 10 whereas that for dead group was
11.5 with the range of 8 to 13. There was 67% probability of death for the patients scoring more
than “7” whereas the score of “7” or less was associated with 100% probability of survival. Regarding
the modified index, the mean score for survived group was 8.5 with the range of 2 to 12
whereas that for dead group was 15 with the range of 14 to 17. There was 100% probability of
survival for the patients having score of “12” or less whereas the score of more than “12” was
associated with 100% probability of death.
CONCLUSION: The proposed modification of Laor’s index appears to be having better predictive
value of outcome but needs to be evaluated in trials having statistical significance.

Key words: Fournier’s gangrene. Fascitis. Prognosis. Severity index. Scoring system.



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