CONUT versus LRINEC, NLR, and SII for predicting clinical severity in survivors of Fournier's gangrene: a retrospective cohort study.

BACKGROUND: Common scoring systems for Fournier's gangrene (FG), such as LRINEC, NLR, and SII, primarily reflect acute inflammatory status. The Controlling Nutritional Status (CONUT) score may provide additional prognostic value. This study aimed to compare CONUT with established laboratory-based indices in predicting clinical severity in FG. METHODS: This retrospective cohort study included adult patients diagnosed with FG between January 2020 and December 2025 at a tertiary referral center. Only patients who survived the acute phase were included. Laboratory-based scores (LRINEC, NLR, SII, and CONUT) were calculated at admission. Primary outcomes were intensive care unit (ICU) requirements and adjacent organ invasion. Secondary outcomes included length of hospital stay (LOS) and number of surgical debridements. ROC-derived optimal cut-off values, and a multivariable logistic regression analysis was performed to identify independent predictors. RESULTS: A total of 116 patients were analyzed. ICU admission was required in 19% of patients, and adjacent organ invasion was observed in 43%. The CONUT score demonstrated the highest predictive accuracy for ICU requirement (AUC = 0.788, p < 0.001). All scoring systems correlated with LOS, with the strongest association observed for CONUT (r = 0.583, p < 0.001). In multivariable analysis, both CONUT (OR: 1.406, p < 0.001) and LRINEC (OR: 1.201, p = 0.021) independently predicted the need for multiple debridements. CONCLUSION: The CONUT score appears to be a predictor of clinical severity in FG. These findings suggest that immunonutritional status may play a critical role in recovery beyond acute inflammatory response.