Fournier’s gangrene (FG) is a rapidly progressing necrotizing fasciitis of the perineum and genital area that carries a high mortality rate. This study aims to identify prognostic factors for mortality in FG patients and compare the predictive accuracy for mortality of three validated scoring systems: Fournier's Gangrene Severity Index (FGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and the Combined Urology and Plastics Index (CUPI).

We conducted a retrospective review of 84 patients treated for FG at our hospital from January 2005 to December 2021. Clinical and biochemical data were collected and analyzed using univariate and multivariate logistic regression to determine associations with mortality. The FGSI, LRINEC, and CUPI scoring systems were evaluated, and receiver operating characteristic (ROC) curves were generated to assess their predictive accuracy for mortality.

Of the 84 patients, 26 died during admission, resulting in a mortality rate of 30.9%. Independent predictors of mortality included serum albumin (OR = 0.23, p = 0.009) and serum glucose (OR = 0.993, p = 0.03). The area under the ROC curve (AUC) for FGSI, LRINEC, and CUPI were 0.622, 0.536, and 0.584, respectively. The optimal cut-off value for FGSI in predicting mortality was 7.5, with a sensitivity of 90% and a specificity of 47%.

Serum albumin and serum glucose levels were found to be significant prognostic factors for mortality in FG patients. Among the scoring systems evaluated, FGSI demonstrated the highest predictive power for mortality, though with moderate accuracy. Future studies are needed to improve prognostic tools for patients with Fournier's gangrene.