Investigation of factors affecting morbidity and mortality in patients diagnosed with Fournier's gangrene in the emergency department

Objective: Fournier's gangrene is a rapidly progressive necrotizing soft tissue infection with a high mortality rate. Early recognition and identification of risk factors are crucial for improving prognosis. The aim of this study was to investigate the demographic, clinical, laboratory, and microbiological characteristics of patients diagnosed with Fournier's gangrene in the emergency department and to determine factors influencing morbidity and mortality. Materials and Methods: This retrospective cross-sectional study was conducted at the Emergency Department of Manisa Celal Bayar University Hafsa Sultan Hospital between January 1 and June 1, 2024. A total of 71 patients diagnosed with Fournier's gangrene were included. Demographics, comorbidities, initial vital signs, laboratory parameters, clinical severity scores, culture results, and one-month outcomes were retrieved from the hospital information system and medical records. Data were analyzed using SPSS 22.0. Parametric and non-parametric tests were applied as appropriate. Receiver Operating Characteristic (ROC) analysis was performed to evaluate the prognostic value of the Neutrophil-to-Lymphocyte Ratio (NLR) and the Systemic Immune-Inflammatory Index (SII) in predicting mortality. Results: The mean age of the patients was 60.3±10.6 years, and 78.9% were male. Diabetes mellitus (71.8%) and hypertension (49.3%) were the most frequent comorbidities. The one-month mortality rate was 14.1%. Patients in the mortality group were significantly older than survivors (70.0±6.5 vs. 58.8±10.3 years, p<0.001). Interestingly, non-smokers had a significantly higher mortality rate compared to smokers (p=0.003). Laboratory analysis revealed that mortality was associated with higher leukocyte count (23.3±15.3 vs. 16.6±6.5 ×10³/µL; p=0.009), NLR (24.6±15.0 vs. 13.0±8.1; p<0.001), SII score (9080.8±6852.1 vs. 3375.8±2520.5; p=0.007), blood urea (100.2±50.9 vs. 56.9±32.0 mg/dL; p=0.005), and creatinine levels (1.6±1.0 vs. 1.1±1.1 mg/dL; p=0.035). ROC analysis demonstrated that both NLR (AUC: 0.746; cutoff: 18.7; sensitivity: 70%; specificity: 82%) and SII (AUC: 0.769; cutoff: 4959; sensitivity: 70%; specificity: 85%) were significant predictors of mortality. Conclusion: Fournier's gangrene remains a life-threatening condition with a substantial mortality risk. Advanced age, non-smoking status, elevated leukocyte count, NLR, SII score, blood urea, and creatinine were significantly associated with mortality. Among these, NLR and SII emerged as reliable prognostic biomarkers for predicting short-term mortality. Early assessment of these parameters in the emergency setting may facilitate timely recognition of high-risk patients and support appropriate treatment strategies. Keywords: Fournier's gangrene, mortality, neutrophil-to-lymphocyte ratio, systemic immune-inflammatory index, risk factors, emergency department.