{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:07:35Z","timestamp":1790010455353,"version":"4.0.1"},"reference-count":40,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Fournier\u2019s gangrene (FG) is a severe necrotizing infection requiring urgent resuscitation, empirical broad-spectrum antimicrobials, and radical debridement. We evaluated established severity scores, Sepsis-3-defined organ dysfunction, and malignancy status in a single-center cohort with surgically confirmed FG. Methods: This retrospective observational study analyzed 21 consecutive adult patients treated between 1 January 2019 and 31 January 2025 at a Romanian tertiary referral center. Pre-treatment baseline FGSI, SFGSI, LRINEC, NLR, SOFA, and qSOFA were calculated. All patients received intravenous antimicrobials within 90 min and underwent surgical debridement within 6 h. In-hospital mortality was assessed via ROC curves, Fisher\u2019s exact test, Haldane\u2013Anscombe odds ratios (ORs), and Firth penalized logistic regression. Results: In-hospital mortality was 19.0% (4\/21). Admission Sepsis-3 sepsis (SOFA \u2265 2) was present in 7\/21 patients (33.3%) and accounted for all four deaths, whereas zero deaths occurred among the 14 patients without organ dysfunction (Fisher\u2019s exact p = 0.006; OR 37.33, 95% CI 1.60\u2013866.90). All nine qSOFA-positive patients without SOFA dysfunction (42.9%) and five patients without organ dysfunction (23.8%) survived. FGSI showed the highest discrimination (AUC 0.934, 95% CI 0.76\u20131.00), followed by SFGSI (AUC 0.919, 95% CI 0.78\u20131.00) and LRINEC (AUC 0.860, 95% CI 0.68\u20130.99); NLR showed poor discrimination (AUC 0.574, 95% CI 0.13\u20131.00). Metastatic solid malignancy was present in 2\/4 non-survivors versus 0\/17 survivors (Fisher\u2019s exact p = 0.029; OR 35.00, 95% CI 1.27\u2013961.40). All four non-survivors met Sepsis-3 criteria (two with and two without metastases). Seven patients required ICU admission (all four non-survivors and three survivors). Conclusions: Admission Sepsis-3-defined organ dysfunction was strongly associated with in-hospital mortality. FGSI and SFGSI demonstrated the highest point-estimate discrimination, LRINEC also showed good discrimination, and NLR demonstrated limited standalone discriminative value. Metastatic malignancy occurred exclusively among non-survivors but overlapped with Sepsis-3-defined sepsis. These findings support the combined assessment of Sepsis-3-defined organ dysfunction and established severity scores for early risk stratification, warranting validation in larger cohorts.<\/jats:p>","DOI":"10.3390\/diseases14090347","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:06:51Z","timestamp":1790006811000},"page":"347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Traditional Prognostic Scores: Associations of Organ Dysfunction and Metastatic Malignancy with Mortality in Fournier\u2019s Gangrene"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8971-8768","authenticated-orcid":false,"given":"Pantelie","family":"Nicolcescu","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Field of Medical and Pharmaceutical Sciences (ReForm-UDJ), \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 47 Domneasc\u0103 Street, 800008 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7739-1685","authenticated-orcid":false,"given":"Alina","family":"Bereanu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Ionela","family":"Mihai","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4762-0755","authenticated-orcid":false,"given":"Manuela","family":"Arbune","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, Research Centre in the Field of Medical and Pharmaceutical Sciences (ReForm-UDJ), \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 47 Domneasc\u0103 Street, 800008 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4482-2618","authenticated-orcid":false,"given":"Mihai","family":"Sava","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, 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Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref_1","first-page":"984","article-title":"Gangr\u00e8ne foudroyante de la verge (overwhelming gangrene). 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Sci."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/9\/347\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:26:28Z","timestamp":1790007988000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/14\/9\/347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diseases14090347"],"URL":"https:\/\/doi.org\/10.3390\/diseases14090347","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]}}}