Progress in Multidisciplinary Treatment of Fournier’s Gangrene

Figures & data

Table 1 CUPI Scoring System.²⁰

Criteria	0	+1	+2
Age (years)	<35	35–50	>50
Hematocrit (%)	30–50	<30	>50
Serum Calcium (mg/dL)	8–10	<8	>10
Serum Alkaline Phosphatase (IU/L)	40–150	<40 or >150
Serum Albumin (g/dL)	>4		<4
INR	1–1.5	1.5–2	>2
Serum Bicarbonate (mEq/L)	20–30	<20 or >30
Total Bilirubin (mg/dL)	0.3–1.9		>1.9
BUN (mg/dL)	10–20	>20

Note: Total score = 0–15.

Table 2 Classification of Necrotizing Fasciitis Based on Pathogenic bacteria^23–28

Types	Pathogen	Location	Risk Factors	Character
Type I (55–80%) polymicrobial	mixed Gram-positive/negative bacteria, and anaerobe	Trunk, Perineum	Comorbidity: DM, CKD and Obesity. Low immunity	Most common
Type II (10–15%) monomicrobial	β-hemolytic Streptococcus Staphylococcus aureus	Limbs	Trauma, surgery, intravenous drug use	MRSA second most common
Type III Rare monomicrobial	Clostridium spp Vibrio vulnificus	Most of the body	Contaminated water or raw oyster, penetrating wounds	Early and severe systemic shock and cardiovascular failure High mortality (30–40%)
Type IV Rare	Aeromonas hydrophila Candida spp zygomycetes	Most of the body	Penetrating wounds, low immunity	High mortality

Table 3 Related Risk Factors for the Development of Fournier’s Gangrene

Comorbidity	Diabetes^Citation16 Alcohol abuse^Citation42 HIV^Citation43 Leukemia^Citation44 Chemotherapy^Citation45,Citation46 Liver disease^Citation16 Atherosclerosis^Citation38
Local factors	Urinary system diseases	Renal abscess^Citation51 Urinary calculi^Citation53 Urethral stricture^Citation52,Citation54
	Anorectal diseases	Perianal abscess^55,56 Thrombotic external hemorrhoids Strangulated inguinal hernia^57,58
	Local skin diseases	Necrotic ulcer^59,60
Invasive operation	Renal abscess^Citation51 Urinary calculi^Citation53 Urethral stricture^Citation52,Citation54

Table 4 The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC Score)⁸²

Variable, Units	Criteria	Points
C-Reactive Protein (mg/L)	<150	0
	≥150	4
Leukocyte count (10^9/L)	<15	0
	15–25	1
	>25	2
Hemoglobin (g/dL)	>13.5	0
	11–13.5	1
	<11	2
Sodium (mmol/L)	≥135	0
	<135	2
Creatinine (µmol/L)	≦141	0
	>141	2
Glucose (mmol/L)	≤10	0
	>10	1

Note: Total score =13.

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