Assessing Mortality Prediction: Comparing the Effectiveness of the Fournier Gangrene Severity Index and the Uludag Index

TL;DR

This study compares two scoring systems for predicting mortality in Fournier’s gangrene patients in Mexico, finding that the Uludag Index performs better.

Contribution

The study evaluates and compares the FGSI and UFGSI in a Mexican cohort, highlighting their prognostic performance in a specific population.

Findings

Overall mortality was 27.7% in the studied cohort of 65 patients with Fournier’s gangrene.

Non-survivors had significantly higher FGSI and UFGSI scores than survivors.

UFGSI showed a stronger association with in-hospital mortality using traditional cutoff values.

Abstract

Background

Fournier’s gangrene (FG) is a fulminant necrotizing infection associated with substantial morbidity and high mortality. Early and accurate risk stratification is essential to guide clinical decision-making. The Fournier Gangrene Severity Index (FGSI) and the Uludag Fournier Gangrene Severity Index (UFGSI) are widely used prognostic tools; however, their comparative performance in Mexican populations remains insufficiently characterized. This study aimed to assess the association of FGSI and UFGSI with in-hospital mortality and to explore their comparative prognostic performance in a Mexican cohort.

Methodology

This retrospective cohort study was conducted at a tertiary-level public hospital in Mexico City. We included 65 adults with confirmed FG treated between July 2022 and February 2025. Clinical, demographic, and laboratory data were collected to calculate FGSI, UFGSI, and the Age-Adjusted Charlson Comorbidity Index. Survivors and non-survivors were compared using Student’s t-test and chi-square tests, and associations with in-hospital mortality were evaluated using multivariate logistic regression with traditional and adjusted cutoff values. Statistical significance was defined as a p-value <0.05.

Results

Overall mortality was 18/65 (27.7%). Most patients were male (44/65, 67.7%), and the mean age was 59.4 ± 11 years. Non-survivors were older than survivors (64.8 ± 10 vs. 57.5 ± 11 years; p < 0.05). The most frequent etiology was proctologic origin (37/65, 56.9%). The most common comorbidity was diabetes (46/65, 70.8%), followed by systemic arterial hypertension (25/65, 38.5%). Mean index scores were higher among non-survivors than survivors for both FGSI (9.1 ± 4 vs. 5.8 ± 3; p = 0.002) and UFGSI (12.6 ± 5 vs. 8.4 ± 4; p = 0.001). Using traditional cutoff points, multivariate logistic regression demonstrated statistically significant associations with mortality for FGSI (odds ratio (OR) = 3.70; 95% confidence interval (CI) = 1.01-13.55; p = 0.048) and UFGSI (OR = 4.70; 95% CI = 1.26-17.44; p = 0.021).

Conclusions

FGSI and UFGSI were both associated with in-hospital mortality in FG. In this cohort, UFGSI showed a stronger association with in-hospital mortality using traditional cutoff values. Larger prospective studies are warranted to validate adjusted cutoff points across diverse clinical settings.

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