Alinejad Khorram Amir, Hojjati Seyyed Ali, Sodeifian Fatemeh, Kolahchi Roya, Farjami Mohammad, Rahnama Hossein, Allameh Farzad
Men's Health & Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arch Acad Emerg Med. 2024 Sep 22;13(1):e10. doi: 10.22037/aaem.v13i1.2408. eCollection 2025.
Fournier's gangrene (FG) is a type of necrotizing fasciitis affecting the external genitalia or perineum. The Geriatric Nutritional Risk Index (GNRI) has been reported as a prognostic factor to evaluate the outcomes of various diseases. This study aimed to investigate the utility of GNRI in predicting the mortality of FG patients.
This retrospective cross-sectional study evaluated the patients admitted to a referral hospital, during 14 years, with diagnosis of FG. The role of GNRI in predicting the mortality of these patients was studied. To further investigate the relationship of the GNRI score with patients' prognosis, we controlled for the scores of Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI).
78 patients with the mean age of 60.79 ± 13.76 (range: 24 -85) years were included in the study (89.74% male). The mortality rate in this series was 23 (29.5%) cases. The survived cases had significantly higher GNRI score (p < 0.001), higher Albumin level (p < 0.001), higher weight (p = 0.04), and lower mortality risk based on FGSI score (p < 0.001). In patients with low mortality risk according to FGSI score (p = 0.036) and mild comorbidities based on CCI score (p = 0.030), the association between GNRI and final prognosis was significant. In contrast, in patients with high mortality risk according to FGSI score (p =0.074) and moderate (p = 0.118) and severe (p = 0.215) comorbidities by CCI score this association was not significant.The independent predictors of mortality in FG patients were GNRI score (OR: 1.242, 95%CI: 1.08, 1.41; p =0.001) and FGSI score (OR: 54.614, 95%CI: 6.89, 432.31; p < 0.001). The area under the receiver operating characteristic (ROC) curve of GNRI score in predicting the mortality of FG patients was 0.84 (95%CI: 0.75 - 0.93). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of GNRI score at the optimal cut-off point (78.5) were, 80%, 77.9%, 60.6%, 90.4%, 3.69, and 0.255 respectively.
Our findings indicate that among patients with mild FG, as assessed by FGSI score, and those with low comorbidities based on CCI score, the GNRI score in survivors was significantly higher than that in non-survived. Additionally, multivariate regression analysis demonstrated that the GNRI score serves as an independent predictor of patient outcomes.
福尼尔坏疽（FG）是一种影响外生殖器或会阴的坏死性筋膜炎。老年营养风险指数（GNRI）已被报道为评估各种疾病预后的一个因素。本研究旨在探讨GNRI在预测FG患者死亡率方面的作用。
这项回顾性横断面研究评估了14年间转诊至一家医院且诊断为FG的患者。研究了GNRI在预测这些患者死亡率方面的作用。为进一步研究GNRI评分与患者预后的关系，我们对福尼尔坏疽严重程度指数（FGSI）评分和Charlson合并症指数（CCI）评分进行了控制。
本研究纳入了78例患者，平均年龄为60.79±13.76（范围：24 - 85）岁（89.74%为男性）。该系列中的死亡率为23例（29.5%）。存活病例的GNRI评分显著更高（p < 0.001）、白蛋白水平更高（p < 0.001）、体重更高（p = 0.04），且基于FGSI评分的死亡风险更低（p < 0.001）。在根据FGSI评分死亡风险较低（p = 0.036）且基于CCI评分合并症较轻（p = 0.030）的患者中，GNRI与最终预后之间的关联显著。相比之下，在根据FGSI评分死亡风险较高（p = 0.074）且根据CCI评分合并症为中度（p = 0.118）和重度（p = 0.215）的患者中，这种关联不显著。FG患者死亡的独立预测因素为GNRI评分（OR：1.242，95%CI：1.08，1.41；p = 0.001）和FGSI评分（OR：54.614，95%CI：6.89，432.31；p < 0.001）。GNRI评分预测FG患者死亡率的受试者工作特征（ROC）曲线下面积为0.84（95%CI：0.75 - 0.93）。在最佳切点（78.5）时，GNRI评分的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为80%、77.9%、60.6%、90.4%、3.69和0.255。
我们的研究结果表明，在根据FGSI评分评估为轻度FG且根据CCI评分合并症较少的患者中，存活者的GNRI评分显著高于未存活者。此外，多因素回归分析表明，GNRI评分是患者预后的独立预测因素。
