Prognostic value of the inflammatory burden index for disease-specific mortality and intensive care need in Fournier’s gangrene

Background: Fournier’s gangrene (FG) is a rapidly progressive necrotizing infection with high mortality. Early recognition of high-risk patients is critical for improving outcomes. Objectives: To evaluate the prognostic value of the Inflammatory Burden Index (IBI)—a composite marker derived from C-reactive protein, neutrophil, and lymphocyte counts—for predicting mortality, intensive care requirements, and clinical course in FG. Design and methods: This retrospective cohort included 130 patients diagnosed with FG and treated at a tertiary referral center between 2015 and 2025. Demographic, clinical, and laboratory data were collected at admission. IBI was calculated using first-draw laboratory values. Primary outcomes were disease-specific mortality and intensive care unit (ICU) admission; secondary outcome was length of hospital stay. Univariable and multivariable logistic regression analyses were performed, and discriminatory capacity was evaluated using receiver operating characteristic analysis. Results: Nonsurvivors exhibited significantly higher IBI values than survivors ( p = 0.001). On multivariable analysis, IBI independently predicted in-hospital mortality ( p = 0.017), disease-specific mortality ( p = 0.004), and ICU admission ( p = 0.008). Higher IBI was also associated with prolonged hospitalization ( p = 0.012). Discriminative performance was acceptable, with an area under the curve of 0.757 for overall mortality and 0.856 for disease-specific mortality. Conclusion: Admission IBI is an independent predictor of mortality, ICU requirement, and hospital stay in FG. As a simple, cost-effective, and rapidly available biomarker, IBI may support early risk stratification and decision-making in clinical practice.