Harnessing radiomics and nutritional metrics to predict long-term survival in Fournier's gangrene patients

Purpose: To evaluate the association of traditional and novel nutritional measurements with survival in Fournier's gangrene (FG) patients. Methods: We reviewed records of FG patients from our tertiary center (Jan 2013-Jan 2022). Radiomic sarcopenia parameters (Psoas Muscle Area [PMA], Roundness, Solidity, and calculated PMA-Index) were measured from admission CT scans at the L3 level using ImageJ software. We assessed sarcopenia's impact on survival through three analyses: Model 1 used a PMI below the sex-adjusted median; Models 2 and 3 used published cutoffs. Kaplan-Meier curves were used to compare survival between sarcopenic and non-sarcopenic patients. Multivariable Cox and logistic regression analyses adjusted for age and the Charlson Comorbidity Index (CCI) to assess mortality risk. Results: Of 130 men and 31 women (82% white), 60 patients (37.3%) had died after a median follow-up of 2.2 years (IQR 0.9-4.4). Survival rates were 94% at 30 days, 92% at 90 days, 80% at 1 year, 77% at 2 years, and 56% at 5 years. Non-survivors were older (median age 63 vs 55.1 years, p < 0.001) and had higher median CCI (4.8 vs 3; p < 0.001). In Model 1, sarcopenic patients had a non-significant increased mortality risk with hazard ratio (HR 1.47, 95% CI 0.82-2.64, p = 0.196). Models 2 and 3 showed similar results (HR 1.41, 95% CI 0.70-2.84, p = 0.325; HR 1.35, 95% CI 0.70-2.61, p = 0.364). None of the models were significant when adjusting for CCI and age. Survivors had better traditional metabolic profiles, including higher albumin (3.1vs 2.7 g/dL), hemoglobin (12.4vs 11.4 g/dL), and lower creatinine (1.39 vs 2.1 mg/dL); however, none of these were significant when adjusting for age and CCI. Results: Of 130 men and 31 women (82% white), 60 patients (37.3%) had died after a median follow-up of 2.2 years (IQR 0.9-4.4). Survival rates were 94% at 30 days, 92% at 90 days, 80% at 1 year, 77% at 2 years, and 56% at 5 years. Non-survivors were older (median age 63 vs 55.1 years, p < 0.001) and had higher median CCI (4.8 vs 3; p < 0.001). In Model 1, sarcopenic patients had a non-significant increased mortality risk with hazard ratio (HR 1.47, 95% CI 0.82-2.64, p = 0.196). Models 2 and 3 showed similar results (HR 1.41, 95% CI 0.70-2.84, p = 0.325; HR 1.35, 95% CI 0.70-2.61, p = 0.364). None of the models were significant when adjusting for CCI and age. Survivors had better traditional metabolic profiles, including higher albumin (3.1vs 2.7 g/dL), hemoglobin (12.4vs 11.4 g/dL), and lower creatinine (1.39 vs 2.1 mg/dL); however, none of these were significant when adjusting for age and CCI. Conclusions: Despite a mild trend, none of the sarcopenia models were able to predict long-term mortality in FG patients in our cohort. This well-known, cost-effective nutritional predictor still requires further research to optimize its utilization in the FG patient population.