THU282 Improved Fournier’s Gangrene Outcomes With Prior SGLT2i Or Metformin Usage

Abstract

Abstract Disclosure: S. Venugopal: None. S. Patel: None. Z. Wu: None. F. Galbiati: None. J. Oh: None. P. Manroa: None. E. Morariu: None. M. Stefanovic-Racic: None. Introduction: Fournier’s gangrene (FG) is a rare, necrotizing fasciitis of the external genitalia with high mortality up to 30% that is more prevalent in males, diabetes, HIV, and immunocompromised states. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been linked with FG. Interestingly, multiple studies have found no significantly increased risk of FG with SGLT2i use. However, these studies have very large confidence intervals due to the rarity of the observed event. Methods: A retrospective study between 3/1/2013-6/12/2020 was performed at four different tertiary hospitals within the University of Pittsburgh Medical Center (UPMC) system to compare the severity and outcome of FG between type 2 diabetes patients who were treated with SGLT2is, metformin, and insulin prior to admission. Results: 202 patients were admitted for FG (8 on SGLT2is, 80 on Metformin, and 88 on insulin). Baseline characteristics such as age, sex, and HbA1c were generally similar. Duration of diabetes was longer in subjects on insulin vs not on insulin (p<0.001). Creatinine(Cr) on admission was lower in SGLT2i vs not on SGLT2i (p=0.056) and metformin vs not on metformin (p=0.037), but was higher in the insulin vs non-insulin group (p=0.004). The SGLT2i group had a shorter hospital stay (p=0.045), a lower rate of ICU admission (p=0.0093), and a trend toward a shorter ICU stay than the non-SGLT2i group (p=0.053). In the metformin group, the cases of amputation were lower compared to the non-metformin group (p=0.026). In the insulin group, there was a trend toward a longer hospital stay (p=0.057) and ICU stay (p=0.052) vs the non-insulin group. Conclusion: The use of SGLT2i does not appear to worsen the clinical course or outcome of FG and may actually improve it based on our data showing decreased ICU admissions and length of stay. Metformin usage may dampen the severity of FG by significantly decreasing cases of amputation. Noteworthy is that Cr was lower in the SGLT2i and metformin groups. Further analysis of baseline characteristics such as renal function, HbA1c, and duration of diabetes will determine whether they may affect the severity of FG. Presentation: Thursday, June 15, 2023