The role of nutritional status in prognosis of Fournier gangrene: a single-center experience.

BACKGROUND AND AIMS: Fournier's gangrene (FG) is a severe and life-threatening necrotizing soft-tissue infection with high mortality. Traditional severity indices may not adequately reflect nutritional and inflammatory status, which are increasingly recognized as important prognostic factors. This study aimed to evaluate the impact of nutritional and inflammatory markers on outcomes in FG.

METHODS

We retrospectively analyzed 45 patients with FG treated between October 2022 and May 2025 at a tertiary hospital. Demographic, clinical, nutritional [body mass index (BMI), serum albumin, psoas muscle index (PMI), Nutritional Risk Screening-2002 (NRS-2002)], and inflammatory parameters [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), hemoglobin-albumin-lymphocyte-platelet (HALP) score] were recorded. Sarcopenia was defined using population-specific PMI cut-offs. Outcomes included in-hospital mortality, length of stay, and surgical interventions. Prognostic performance was assessed with ROC curves and logistic regression.

RESULTS

Overall mortality was 24.4%. Non-survivors had lower serum albumin (22.9 vs. 27.4 g/L, p = 0.035), lower PMI (4.1 vs. 5.7 cm2/m2, p = 0.033), and higher NRS-2002 scores (3.0 vs. 0.7, p < 0.001). Sarcopenia was frequent (58.1%) and present across all BMI categories, indicating sarcopenic obesity. NRS-2002 showed the strongest predictive ability for mortality (AUC 0.849).

CONCLUSION

Nutritional impairment and sarcopenia are common in FG and strongly associated with adverse outcomes. Incorporating nutritional markers into severity assessment may enhance prognostic accuracy and support early nutrition-focused interventions.