Geriatric Nutritional Risk Index in Predicting the Mortality of Fournier's Gangrene: Analysis of 14-Year Statistics of Referral Center
Archives of Academic Emergency Medicine,
Vol. 13 No. 1 (2025),
6 September 2025
,
Page e10
https://doi.org/10.22037/aaem.v13i1.2408
Abstract
Introduction: 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.
Methods: 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).
Result: 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.
Conclusions: 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.
- Fasciitis
- Genitalia
- Mortality
- Prognosis
How to Cite
References
Ruiz-Tovar J, Cordoba L, Devesa JM. Prognostic factors in Fournier gangrene. Asian J Surg. 2012;35(1):37-41.
Wetterauer C, Ebbing J, Halla A, Kuehl R, Erb S, Egli A, et al. A contemporary case series of Fournier’s gangrene at a Swiss tertiary care center—can scoring systems accurately predict mortality and morbidity? World J Emerg Surg. 2018;13:1-6.
Thayer J, Mailey BA. Two-stage neoscrotum reconstruction using porcine bladder extracellular Matrix after Fournier’s Gangrene. Plast Reconstr Surg Glob Open. 2020;8(8):e3034.
El-Shazly M, Aziz M, Aboutaleb H, Salem S, El-Sherif E, Selim M, et al. Management of equivocal (early) Fournier’s gangrene. Ther Adv Urol. 2016;8(5):297-301.
Tarchouli M, Bounaim A, Essarghini M, Ratbi MB, Belhamidi MS, Bensal A, et al. Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases. Can Urol Assoc J. 2015;9(11-12):E800.
Sorensen MD, Krieger JN, Rivara FP, Broghammer JA, Klein MB, Mack CD, et al. Fournier's Gangrene: population based epidemiology and outcomes. J Urol. 2009;181(5):2120-6.
Benjelloun EB, Souiki T, Yakla N, Ousadden A, Mazaz K, Louchi A, et al. Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality. World J Emerg Surg. 2013;8:1-5.
Jeong HJ, Park SC, Seo IY, Rim JS. Prognostic factors in Fournier gangrene. Int J Urol. 2005;12(12):1041-4.
Djafari AA, Rahavian A, Javanmard B, Montazeri S, Shahabi V, Hojjati SA, et al. Factors related to mortality in patients with Fournier’s gangrene or necrotising fasciitis; a 10-year cross-sectional study. Arch Acad Emerg Med. 2021;9(1).
Bellanti F, Lo Buglio A, Quiete S, Vendemiale G. Malnutrition in hospitalized old patients: screening and diagnosis, clinical outcomes, and management. Nutrients. 2022;14(4):910.
Komolsuradej N, Srikrajang S, Rangsiprakarn N, Wongaree A, Wasusathapon C, Kanjanakomut D, et al. The Strong Correlation Between Pain Interference and Abnormal Nutritional Status in Older Adults With Chronic Musculoskeletal Pain. J Prim Care Community Health. 2023;14:21501319231174116.
Su W-T, Wu S-C, Huang C-Y, Chou S-E, Tsai C-H, Li C, et al. Geriatric nutritional risk index as a screening tool to identify patients with malnutrition at a high risk of in-hospital mortality among elderly patients with femoral fractures—a retrospective study in a level i trauma center. Int J Environ Res Public Health. 2020;17(23):8920.
Kuo I-C, Huang J-C, Wu P-Y, Chen S-C, Chang J-M, Chen H-C. A low geriatric nutrition risk index is associated with progression to dialysis in patients with chronic kidney disease. Nutrients. 2017;9(11):1228.
Matsumura T, Mitani Y, Oki Y, Fujimoto Y, Ohira M, Kaneko H, et al. Comparison of Geriatric Nutritional Risk Index scores on physical performance among elderly patients with chronic obstructive pulmonary disease. Heart Lung. 2015;44(6):534-8.
Nishi I, Seo Y, Hamada‐Harimura Y, Yamamoto M, Ishizu T, Sugano A, et al. Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction. ESC Heart Fail. 2019;6(2):396-405.
Xiang Q, Li Y, Xia X, Deng C, Wu X, Hou L, et al. Associations of geriatric nutrition risk index and other nutritional risk-related indexes with sarcopenia presence and their value in sarcopenia diagnosis. BMC Geriatr. 2022;22(1):327.
Lidoriki I, Schizas D, Frountzas M, Machairas N, Prodromidou A, Kapelouzou A, et al. GNRI as a prognostic factor for outcomes in cancer patients: a systematic review of the literature. Nutr Cancer. 2021;73(3):391-403.
Lv G-y, An L, Sun D-w. Geriatric nutritional risk index predicts adverse outcomes in human malignancy: a meta‐analysis. Dis Markers. 2019;2019(1):4796598.
Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent J-P, Nicolis I, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777-83.
Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom. 2022;91(1):8-35.
Doluoğlu ÖG, Karagöz MA, Kılınç MF, Karakan T, Yücetürk CN, Sarıcı H, et al. Overview of different scoring systems in Fournier’s gangrene and assessment of prognostic factors. Turk J Urol. 2016;42(3):190.
Khorram AA, Allameh F, Eslami A. Fournier's gangrene caused by urethral manipulation in a seven-year-old boy: A case report. Urol Case Rep. 2023;50:102483.
Roghmann F, von Bodman C, Löppenberg B, Hinkel A, Palisaar J, Noldus J. Is there a need for the Fournier's gangrene severity index? Comparison of scoring systems for outcome prediction in patients with Fournier's gangrene. B BJU Int. 2012;110(9):1359-65.
Allameh F, Montazeri S, Shahabi V, Hojjati SA, Khorram AA, Razzaghi Z, et al. Assessment of the prognostic effect of blood urea nitrogen to serum albumin ratio in patients with Fournier’s gangrene in a referral center. Urol J. 2021;19(04):325-8.
Abd-El-Gawad WM, Abou-Hashem RM, El Maraghy MO, Amin GE. The validity of Geriatric Nutrition Risk Index: simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment. Clin Nutr. 2014;33(6):1108-16.
Cereda E, Pedrolli C, Zagami A, Vanotti A, Piffer S, Faliva M, et al. Nutritional risk, functional status and mortality in newly institutionalised elderly. Br J Nutr. 2013;110(10):1903-9.
Kaneko H, Suzuki S, Goto M, Yuzawa Y, Arita T, Yagi N, et al. Geriatric nutritional risk index in hospitalized heart failure patients. Int J Cardiol. 2015;181:213-5.
Komatsu M, Okazaki M, Tsuchiya K, Kawaguchi H, Nitta K. Geriatric nutritional risk index is a simple predictor of mortality in chronic hemodialysis patients. Blood Purif. 2015;39(4):281-7.
Li L, Wang H, Yang J, Jiang L, Yang J, Wu H, et al. Geriatric nutritional risk index predicts prognosis after hepatectomy in elderly patients with hepatitis B virus-related hepatocellular carcinoma. Sci Rep. 2018;8(1):12561.
Sasaki M, Miyoshi N, Fujino S, Ogino T, Takahashi H, Uemura M, et al. The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery. Sci Rep. 2020;10(1):10744.
Bo Y, Wang K, Liu Y, You J, Cui H, Zhu Y, et al. The geriatric nutritional risk index predicts survival in elderly esophageal squamous cell carcinoma patients with radiotherapy. PLoS One. 2016;11(5):e0155903.
Liu W, Li M, Lian S, Hou X, Ling Y. Geriatric nutritional risk index as a predictor for postoperative complications in patients with solid cancers: a meta-analysis. Front Oncol. 2024;14.
Yeniyol CO, Suelozgen T, Arslan M, Ayder AR. Fournier's gangrene: experience with 25 patients and use of Fournier's gangrene severity index score. Urology. 2004;64(2):218-22.
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