A Commentary on “Clinical Characteristics and Risk Factors of Fournier Gangrene: A 15-Years Multicenter Retrospective Study in Korea”
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To the editor,
I read with great interest the study by Choi et al. [1] investigating the clinical characteristics and mortality-related risk factors of Fournier gangrene (FG) based on a 15-year multicenter cohort in Korea. This study provides valuable insight into a rare but life-threatening condition and highlights clinically relevant predictors associated with adverse outcomes.
FG remains a rapidly progressive and life-threatening necrotizing infection with substantial mortality despite advances in surgical and critical care management [2,3]. As noted by the authors, mortality rates have not significantly improved over time, underscoring the importance of early recognition and appropriate risk stratification. These findings are also consistent with recent guideline recommendations emphasizing early recognition and risk stratification in severe urogenital infections [4]. The identification of diabetes mellitus and elevated respiratory rate as independent predictors of mortality is consistent with the established role of metabolic dysregulation and systemic inflammatory response in the progression of FG [1,5].
Notably, the association between respiratory rate and mortality is of particular clinical relevance. Respiratory rate is a simple and readily obtainable bedside parameter and may reflect early systemic physiological deterioration associated with sepsis [5,6]. Its prognostic significance in FG suggests that basic physiological indicators may play a crucial role in early risk assessment and triage, especially in emergency settings.
The borderline association observed for the Fournier gangrene severity index (FGSI) is also noteworthy. Although FGSI has been widely used as a prognostic tool, its performance has varied across different patient populations. The present findings suggest that while FGSI remains clinically useful, its predictive value may be enhanced when interpreted in conjunction with individual clinical parameters, including the respiratory rate and comorbid conditions.
I encourage future studies to explore integrated risk stratification models combining clinical, laboratory, and scoring system variables—such as hemodynamic instability, inflammatory biomarkers, and response to initial resuscitation—to improve prognostic accuracy. In addition, prospective multicenter studies would be valuable for validating these findings and establishing standardized management pathways for FG.
In summary, Choi et al. [1] provide important contemporary data on FG in the Korean population. Their findings reinforce the persistent clinical burden of FG and highlight the importance of early recognition and riskbased management strategies in routine clinical practice.
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Conflict of Interest
JYK, member of the Editorial Board of Urogenital Tract Infection, is author of this letter. However, he played no role whatsoever in the editorial evaluation of this article or the decision to publish it. Except for that, the author has nothing to disclose.