Prognostic value of inflammatory and metabolic markers in Fournier's gangrene: a single-center retrospective analysis.

backgroundFournier's gangrene (FG) is a rapidly progressive, life-threatening necrotizing fasciitis of the perineal and genital region. Despite advances in surgical and medical management, morbidity remains high. Early identification of disease severity and prognosis is essential for timely intervention. This study aimed to evaluate the prognostic value of routinely available inflammatory and metabolic markers-particularly C-reactive protein (CRP) and white blood cell (WBC) count-and to establish clinically applicable admission cut-off values for predicting clinical outcomes, including prolonged hospitalization and surgical burden.

methodsThis retrospective single-center study included 40 patients diagnosed with and treated for FG at Niğde Ömer Halisdemir University Training and Research Hospital between 2022 and 2025. Demographic, laboratory, and clinical data were reviewed. Laboratory parameters, including WBC count, CRP, glucose, and derived indices such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), were recorded at three time points: admission, post-first debridement, and pre-discharge. Patients were stratified according to diabetes mellitus (DM) status, antibiotic regimen, and surgical complexity. The primary outcome was prolonged hospitalization (>14 days), and the secondary outcome was the need for multiple debridements (≥3 procedures). Statistical analyses included the Friedman test for repeated measures, Spearman correlation analysis, logistic regression, and receiver operating characteristic (ROC) analysis.

resultsThe mean age was 56.8±17.9 years, and 40% of patients had DM. The most common etiology was scrotal abscess (57.5%). Serial laboratory assessment demonstrated significant reductions in WBC count (median: 13.1→8.2 ×10³/µL, p<0.001) and CRP level (median: 90.4→34.6 mg/L, p<0.001) following serial debridements. Admission CRP and WBC levels showed positive correlations with both length of hospital stay (ρ=+0.46 and +0.41, respectively) and number of debridements (ρ=+0.39 and +0.36, respectively). In multivariate regression analysis, CRP was the only independent predictor of prolonged hospitalization (odds ratio=1.07, 95% confidence interval: 1.02-1.14; p=0.009). ROC analysis identified a CRP threshold of ≥128 mg/L (area under the curve=0.86) as the optimal cut-off value for predicting prolonged hospitalization. No mortality occurred during the study period.

conclusionCRP and WBC count are practical, inexpensive, and reproducible markers of disease severity and treatment response in patients with Fournier's gangrene. Serial monitoring of these parameters may facilitate early risk stratification, guide decisions regarding repeat debridement, and support optimization of antibiotic and surgical management. Incorporation of these readily available inflammatory markers into standardized treatment protocols may improve clinical decision-making and patient outcomes in FG.