Fournier’s gangrene mortality; A 17- year systematic review and meta-analysis

Abstract Background To provide better management of the disease, mortality-associated comorbidities, and common etiologies were identified. Method Systematic search was conducted through twelve databases, followed by meticulous screening to select relevant articles. Meta-analysis and meta-regression (for possible cofounders) were both done for all possible outcomes. Result Out of 1186 reports screened, we finally included 38 studies for our systematic review and meta-analysis. A higher risk of mortality was detected in patients with diabetes, heart disease, renal failure and kidney disease with the risk ratio (RR) and 95% confidence interval of 0.72 (95%CI 0.59-0.89), 0.39 (0.24-0.62), 0.41 (95%CI 0.27-0.63) and 0.34 (95%CI 0.16-0.73), respectively. However, there was no association between mortality rates and co-morbid hypertension, lung disease, liver disease and malignant disease (p > 0.05). The highest mortality rates were due to sepsis (76%) and multiple organ failure (66%), followed by the observed mortality rates due to respiratory (19.4%), renal (18%), cardiovascular (15.7%) and hepatic (5%). Conclusion Modifications in Fournier Gangrene Severity Index (FGSI), to include comorbidities as an important prognostic tool for FG mortality, are recommended. Close monitoring of the patients, with special interest given to the main causes of mortality, is an essential element of the management process.