Fournier’s gangrene: outcome analysis and prognostic factors

  • Christopher Shingirirai Meki University of Zimbabwe
  • Tonderayi I Mangwiro University of Zimbabwe
  • John Lazarus University of Cape Town
Keywords: Fournier’s gangrene, mortality, necrotising fasciitis, debridement


Background: Fournier’s gangrene is an infective necrotising fasciitis of the external genitalia and perineum associated with significant morbidity and mortality. The factors associated with non survival have been described but are not universally accepted. The identification of prognostic factors remains critical to improve outcomes.

Objectives: To determine the hospital based mortality and factors associated with non-survival among subjects with a clinical diagnosis of Fournier’s gangrene.

Methods: A prospective hospital based observational study on 51 patients with a clinical diagnosis of Fournier’s gangrene over a 2-year period. A comparison was made between survivors and non-survivors to establish prognostic factors associated with non survival.

Results: The disease related hospital mortality was 27% (14/51). The mean age of the 51, all male patients was 47 years. An older age was significantly associated with non-survival (p=0.02). The presence of renal dysfunction (p=0.001), severe sepsis (p=0.000), delay in surgical debridment (p=0.04), urogenital source of infection (p=0.01), a body surface area involvement of greater than 5% (p=0.006), abdominal wall involvement (p=0.02) on admission were significant factors associated with mortality. The presence of either HIV infection or diabetes mellitus was not a prognostic indicator of mortality. The clinical and biochemical parameters on admission associated with non survival were a high respiratory rate (p=0.03), a low hemoglobin (p=0.0001), an elevated blood urea nitrogen (p=0.005) and creatinine (p=0.01). Multivariate logistic regression analysis did not show any independent factors associated with non survival.

Conclusion: Fournier’s gangrene remains a fatal condition with a hospital mortality of 27%. Prognostic factors for non survival include an advanced age, a urogenital source of infection, abdominal involvement, severe sepsis and renal dysfunction.

Author Biographies

Christopher Shingirirai Meki, University of Zimbabwe

Department of Surgery
University of Zimbabwe

Tonderayi I Mangwiro, University of Zimbabwe

Department of Surgery
University of Zimbabwe

John Lazarus, University of Cape Town

Division of Urology
Faculty of Health Sciences
University of Cape Town

How to Cite
Meki, C., Mangwiro, T., & Lazarus, J. (2018). Fournier’s gangrene: outcome analysis and prognostic factors. South African Journal of Surgery, 56(3), 43-46. Retrieved from