Published 2013-07-01
Basuki Bambang Purnomo


Objective: To demonstrate the usefulness of Fournier’s Gangrene Severity Index (FGSI) score for differentiating the outcome between Systemic Inflammatory Response Syndrome (SIRS) patients with upper and lower urological abnormalities. Material & Method:A retrospective study of case records from year 2009-2012 of SIRS patients with urological abnormalities at Saiful Anwar General Hospital (SAGH) Malang was carried out. The data were collected from the Medical Record Division in SAGH Malang. SIRS was clinicaly diagnosed based on medical history, physical examination and laboratory findings. SIRS without urological abnormalities were excluded from the analysis. The FGSI, which was developed to assign a numerical score that describes the severity of disease, was used in our study. This index presents patients vital signs (temperature, heart and respiratory rates) and metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, hematocrit, and white blood cell count). Patients with SIRS and urological abnormalities were divided according to upper tract and lower tract urological abnormalities. Total FGSI score was classified as mild (0-8), moderate (9-17), severe (> 17). The data were assessed according to whether the patient survived or died.Results:75 of the 203 evaluated patients died. From those 75 patients, 67% were male and 33% were female, 75% with upper urological abnormalities and 25% with lower abnormalities (p < 0,05). From those 203 patients; the results were analyzed with binary logistical regression and Spearman correlation analysis using SPSS 15 softwarewith 95% confidence interval (CI). There is significant relationship between FGSI and outcome of the patient with upper urological abnormalities and lower urological abnormalities, with correlation coefficient more high in relationship between FGSI and outcome of the patient with upper urological abnormalities (0,4 vs 0,1). Conclusion: FGSI is simple and objective outcome predictor to differentiate survival between SIRS patients with upper urological abnormalities and lower urological abnormalities. There is a significant difference in outcome between SIRS patient with upper urological abnormalities and lower urological abnormalities even with same level of FGSI score.Keywords: Fournier’s gangrene severity index, systemic inflammatory response syndrome, upper urological abnormalities, lower urological abnormalities, outcome predictor.



M. Grabe. Guidelines on urological infections, sepsis syndrome in urology (urosepsis). European Association of Urology. 2011; 5: 33–7.

Bone RC, Balk RA, Cerra FB. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101(6): 1644-55.

Levy MM, Fink MP, Marshall JC. SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003; 31(4): 1250-6.

Dellinger RP, Carlet JM, Masur H. Surviving sepsis campaign management guidelines committee. Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock. Crit Care Med. 2004; 32: 858-73. pubmed/15090974.

Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier’s Gangrene. J Urol. 1995; 154: 89.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003; 31: 1250.

Martin GS, Mannino DM, Eaton S. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003; 348(16): 1546-54. http://www.ncbi.nlm.

Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003; 348(2): 138-50.

Rosser CJ, Bare RL, Meredith JW. Urinary tract infections in the critically ill patient with a urinary catheter. Am J Surg. 1999; 177(4): 287-90. pubmed/10326844.

Brun-Buisson C, Meshaka P, Pinton P. EPISEPSIS Study Group. EPISEPSIS: A reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004; 30(4): 580-8.

Copyright Information
Department of Urology, Faculty of Medicine/Airlangga University