Diagnostic Accuracy of Red Cell Distribution Width-Derived Indices for Predicting In-Hospital Mortality in Scrotal Fournier’s Gangrene: A Retrospective Cohort Study

Purpose: Fournier's gangrene (FG) is a rapidly progressive, life-threatening necrotizing fasciitis with mortality rates ranging from 20% to 50%. Despite advances in management, reliable and readily accessible prognostic markers for early mortality risk stratification remain limited. This study aimed to assess the prognostic utility of red cell distribution width (RDW) and RDW-derived indices in predicting in-hospital mortality in patients undergoing surgical treatment for scrotal FG. Materials and Methods: A retrospective cohort analysis was conducted on patients treated surgically for scrotal FG between January 2012 and January 2025. Preoperative laboratory parameters, including RDW, albumin, neutrophil, lymphocyte, and platelet counts, were collected. Derived indices-RDW-to-albumin ratio (RAR), RDW-to-lymphocyte ratio (RLR), and RDW-to-platelet ratio (RPR)-were calculated. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC) analyses were performed to evaluate the diagnostic performance of these indices. Results: Of the 62 patients included, 17.7% died during hospitalization. Although stand-alone RDW levels were not substantially associated with mortality, the RAR exhibited excellent predictive accuracy (area under the curve = 0.955). RLR, RPR, and neutrophil-to-lymphocyte ratio (NLR) also showed substantial prognostic value. Non-survivors had markedly lower serum albumin and hemoglobin concentrations and higher creatinine and NLR values. Post-operative intensive care unit admission and bowel diversion were strongly associated with mortality. Conclusion: RDW-derived indices, particularly RAR, appear to be robust, easily obtainable biomarkers for early mortality risk prediction in scrotal FG. Their integration into clinical evaluation algorithms may enhance prognostic precision and guide timely interventions. Further multi-center prospective studies are warranted to confirm these findings and support their routine use in clinical practice.