THE PROGNOSTIC ROLE OF NEUTROPHIL- LYMPHOCYTE RATIO IN FOURNIER GANGRENE PATIENTS Muhammad Achdiar Raizandha 1,2 , Furqan Hidayatullah 1,2 , Yudhistira Pradnyan Kloping 1,2 , Fikri Rizaldi 1,3 1,2 Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital 3 Department of Urology, Faculty of Medicine, Universitas Airlangga Rumah Sakit Universitas Airlangga Teaching Hospital ABSTRACT Fournier gangrene is a rare type of necrotizing fasciitis which affects the perineal, genital, or anorectal region. It is considered as a urological emergency as it has a high mortality rate, at 20 to 50% in most reported series. Our aim was to evaluate the role of neutrophil-lymphocyte ratio as a prognostic marker for Fournier gangrene patients. There is an increasing interest in suggesting the correlation between inflammatory status and disease prognosis, one of the most commonly used parameter is the neutrophil- lymphocyte ratio (NLR). This is an analytical study with a retrospective approach evaluating the medical record data of patients diagnosed with Fournier gangrene admitted to Dr. Soetomo General Academic Hospital from January 2012 to November 2020. A total of 109 patients aged approximately 50.31 years old were included in this study. The average NLR of the patients was 15.86, indicating a high NLR compared to the ratio found in healthy people. The area under curve value was 0.65 (95% CI; 0,524-0,754; p < 0,05). The Kaplan-Meier curve in figure 2 showed that the NLR cut-off value of 10.9 has a significant impact on the patient’s mortality rate (95% CI ; 29,7-19,7; p < 0,05). This study revealed that NLR can be used as an indicator of poor prognosis in FG patients with a cut-off point value of 10.9. Keywords: Fournier gangrene, neutrophil-lymphocyte ratio, NLR, prognostic factor 1. INTRODUCTION Fournier gangrene is a rare type of necrotizing fasciitis which affects the perineal, genital, or anorectal region. It is characterized by a widespread soft tissue necrosis and systemic toxicity of the superficial fascia and subcutaneous tissues [1] . Even though it is quite uncommon, constituting only 0.02% of all hospital admissions, it is considered as a urological emergency as it has a high mortality rate, at 20 to 50% in most reported series [2,3] . In the recent years, the incidence of Fournier gangrene is increasing with the increase of diabetes prevalence and the number of immunocompromised patients due to various causes [4] . Previous studies have determined possible risk factors for predicting the prognosis of Fournier gangrene patients [5–7] . Parameters to determine the severity and prognosis of the disease have been suggested, one of which is the Fournier Gangrene Severity Index (FGSI), commonly used to assess the severity of the disease by evaluating clinical and laboratory parameters, such as temperature, heart rate, respiratory rate, serum sodium, serum potassium, serum creatinine, serum bicarbonate, hematocrit and white blood cell count [8] . Since its introduction by Laor et al, the score has been validated by many studies, however, its accuracy remains questionable [9,10] . Nevertheless, it is the only well-known tool to assess severity [10] . Recent findings have suggested simple and promising parameters by utilizing normal laboratory findings. There is an increasing interest in predicting the prognosis patients with simple blood test since studies began suggesting the correlation between inflammatory status and disease prognosis. One of the most commonly used parameter is the neutrophil-lymphocyte ratio (NLR) [11] . Findings regarding its potential use in predicting the prognosis of Fournier gangrene patients have been reported, however more investigations are still needed to determine its value as a biomarker [12–14] . Therefore, we aimed to evaluate the role of neutrophil- lymphocyte ratio as a prognostic marker for Fournier gangrene patients. 2. MATERIAL AND METHODS This is an analytical study with a retrospective approach evaluating the medical record data of patients diagnosed with Fournier gangrene admitted to Dr. Soetomo General Academic Hospital from January 2012 to November 2020. All adult patients aged 18 and above with Fournier gangrene and complete laboratory examination data including neutrophile and lymphocyte count were included for an analysis. Patients with a history of malignancy or chemoradiation were excluded. Patients with incomplete or unclear data in the medical records were also excluded. The data collected and presented included patient age, diagnosis, lesion location, comorbidities, FGSI, bacterial culture results, surgical intervention, and survival status. The collected data were grouped and displayed descriptively in the form of tables and narratives. The association between the binary marker of NLR and the risk of mortality is evaluated using a survival curve. The separation between the curves among patients with a high NLR and a low NLR indicated the prognostic ability of the marker represented by a receiver operating characteristic (ROC) curve [15] . The performance of the marker was evaluated by area under the curve (AUC), which is a measure of the ability of a tool to discriminate whether a condition 268 www.ijrp.org IJRP 2021, 89(1), 268-271; doi:.10.47119/IJRP1008911120212492