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Adult male Fournier gangrene hospitalizations with and without end-stage kidney disease: A 5-year nationwide analysis 

Jay Manadan and William Whittier

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Volume 105 (2026) p. 384 - 389

Abstract

Clinical Nephrology, Vol. 105 – No. 6/2026 (384-389)

Adult male Fournier gangrene hospitalizations with and without end-stage kidney disease: A 5-year nationwide analysis 

Jay Manadan and William Whittier

Division of Nephrology, Rush University Medical Center, Chicago, IL, USA
Introduction: Fournier gangrene (FG) is a severe acute necrotizing fasciitis affecting the genitalia and carries a high mortality. Patients with end-stage kidney disease (ESKD) are an overlooked but potentially vulnerable subgroup given their high burden of comorbidities. As such, we aimed to study FG in those with and without ESKD.
Materials and methods: We conducted a retrospective analysis of all adult male FG hospitalizations from 2017 – 2021 in the National Inpatient Sample (NIS) database. We sought to identify independent predictors of in-hospital mortality. Univariable logistic regression analyses were used to calculate unadjusted odds ratios (OR) for an outcome of in-hospital death. All variables with p-values ≤ 0.2 were included in a multivariable logistic regression model. P-values ≤ 0.05 were considered significant in the multivariable analysis.
Results: Among 35,415 adult hospitalizations with FG in the NIS database, 2,210 (6.2%) had ESKD. Those with FG and ESKD, compared to those without ESKD, had higher rates of diabetes mellitus (DM) (85.3 vs. 65.1%; p < 0.001), higher in-hospital mortality (13.4 vs. 5.3%; p < 0.001), greater median length of stay (LOS) (10 vs. 8 days; p < 0.001), and greater median total hospital charges (USD 119,402 vs. 89,108; p < 0.001). The prevalence of sepsis was very high but similar between the groups (59.7 vs. 56.8%; p = 0.230). Multivariable analysis revealed the following factors were independently associated with higher odds of in-hospital death: age (OR 1.04; 95% CI: 1.033 – 1.055), alcohol abuse (OR 2.31; 95% CI: 1.622 – 3.278), and ESKD (OR 3.14; 95% CI: 2.279 – 4.331).
Conclusion: Patients with ESKD represent a distinct and high-risk subgroup, characterized by longer hospital LOS, increased total hospital charges, and over three-fold increased odds of in-hospital death. Comorbid DM was found in the majority of cases suggesting it was a strong FG risk factor, but DM itself did not independently increase the odds of in-hospital death. Sepsis was a very common complication and the most frequent cause of death. These findings underscore the need for targeted management strategies and early recognition of high-risk features in FG patients, particularly those with underlying ESKD, to improve outcomes in this severe and complex condition.Correspondence to:
William Luke Whittier, MD, FASN, Professor of Medicine
or
Jay Manadan, Research Student
Division of Nephrology
Rush University Medical Center
Chicago, IL, USA
Email: [email protected]; [email protected]

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