European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
Clinical and laboratory predictors of mortality in Fournier's gangrene: prognostic role of the HALP score.
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Yavuz Ahmet, Ersöz Vildan, Çamöz Mehmet Sefa, Yurdakul Zeynep Nur, İğdeci Tut Gözde, Demirci Behzat Fatih, Koçsoy Nadir Samet, Dönmez Mustafa
Аннотация
OBJECTIVE: Fournier's gangrene (FG) is a rapidly progressive necrotizing soft-tissue infection associated with substantial mortality. This study evaluated the prognostic performance of the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score and routinely available clinical and laboratory parameters in patients with FG.
METHODS: This retrospective cohort study included 236 consecutive patients who underwent surgical treatment for FG between February 2019 and May 2025. The primary outcome was in-hospital mortality. Prognostic factors were evaluated using univariate and multivariable logistic regression analyses, and discriminative performance was assessed by receiver operating characteristic (ROC) curve analysis.
RESULTS: The overall in-hospital mortality rate was 12.3%. Non-survivors had significantly lower HALP scores, hemoglobin, hematocrit, albumin, lymphocyte, and monocyte levels (all p < 0.05). In univariate analysis, younger age, disease confined to the perianal region, and higher albumin, monocyte, hemoglobin, hematocrit, and HALP values were associated with survival. In the primary multivariable model, advanced age (OR = 0.966, 95% CI: 0.936-0.997; p = 0.030) and monocyte count (OR = 5.243, 95% CI: 1.055-26.049; p = 0.043) remained independent predictors of survival. Hemoglobin showed the highest discriminative performance (AUC = 0.781), followed by albumin (0.767), hematocrit (0.751), and the HALP score (0.707). DeLong analysis demonstrated no significant differences between the AUC of the HALP score and those of the individual laboratory parameters.
CONCLUSION: Advanced age and lower monocyte count were independently associated with poorer outcomes in patients with FG. Although the HALP score was significantly associated with survival, it did not retain independent prognostic significance after multivariable adjustment. Overall, the HALP score may serve as a complementary risk assessment tool rather than a replacement for routinely available laboratory parameters or established prognostic scoring systems. Further prospective multicenter studies are warranted to validate these findings.
METHODS: This retrospective cohort study included 236 consecutive patients who underwent surgical treatment for FG between February 2019 and May 2025. The primary outcome was in-hospital mortality. Prognostic factors were evaluated using univariate and multivariable logistic regression analyses, and discriminative performance was assessed by receiver operating characteristic (ROC) curve analysis.
RESULTS: The overall in-hospital mortality rate was 12.3%. Non-survivors had significantly lower HALP scores, hemoglobin, hematocrit, albumin, lymphocyte, and monocyte levels (all p < 0.05). In univariate analysis, younger age, disease confined to the perianal region, and higher albumin, monocyte, hemoglobin, hematocrit, and HALP values were associated with survival. In the primary multivariable model, advanced age (OR = 0.966, 95% CI: 0.936-0.997; p = 0.030) and monocyte count (OR = 5.243, 95% CI: 1.055-26.049; p = 0.043) remained independent predictors of survival. Hemoglobin showed the highest discriminative performance (AUC = 0.781), followed by albumin (0.767), hematocrit (0.751), and the HALP score (0.707). DeLong analysis demonstrated no significant differences between the AUC of the HALP score and those of the individual laboratory parameters.
CONCLUSION: Advanced age and lower monocyte count were independently associated with poorer outcomes in patients with FG. Although the HALP score was significantly associated with survival, it did not retain independent prognostic significance after multivariable adjustment. Overall, the HALP score may serve as a complementary risk assessment tool rather than a replacement for routinely available laboratory parameters or established prognostic scoring systems. Further prospective multicenter studies are warranted to validate these findings.