Evaluation of early scoring predictors for expedited care in patients with emphysematous pyelonephritis

Abstract

Introduction: Emphysematous pyelonephritis (EPN), an acute necrotizing infection of the kidney and surrounding tissues, is associated with considerable mortality. We evaluated how existing critical care scoring systems could predict the need for intensive care unit (ICU) management for these patients. We also analyzed if CT-imaging further enhances these predictive systems. Patients and Methods: A retrospective analysis of 90 consecutive patients diagnosed clinico-radiologically with EPN from January 2011 to September 2020. Five scoring systems were evaluated for their predictive ability for the need for ICU management and mortality risk: National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), ‘quick’ Sequential Organ Failure Assessment score (qSOFA), Systemic Inflammatory Response Syndrome score (SIRS), and Sequential Organ Failure Assessment score (SOFA). CT images were classified as per Huang & Tseng and evaluated as stand-alone or added to the different predictive models. Receiver operating characteristic (ROC) curves were plotted for each critical care score and CT-Class using logistic regression, to obtain the area under curve (AUC) value for comparison of ICU admission predictability. Patients were analyzed up till discharge. Results: Ninety patients were diagnosed with EPN. Twenty-six patients required ICU management and nine patients died. The best scoring system to predict the need of early ICU management is NEWS (AUC 0.884). CT Class had no independent predictive power, nor did it add significantly to improvement in most of the early warning scoring systems, but rather guided us to the need for radiological, endourological or surgical intervention. Conclusion: In patients with EPN, the NEWS scoring system predicts best the requirement of ICU care. It aids in triage of patients with EPN to appropriate early management and reduce mortality risk.

Comparison of prognosis of five scoring systems in emphysematous pyelonephritis patients requiring intensive care

“…Chawla et al reviewed 90 EPN patients and found that NEWS score was the best at predicting the need for ICU admission. Like in our study, the author found that NEWS score ≥ 5 was the best predictor of the need for urgent admission to the ICU [ 22 ]. In terms of predicting EPN mortality, Krishnamoorthy et al prospectively reviewed 131 EPN patients in 2019 and proposed a prognostic scoring system to predict mortality including 18 parameters [ 23 ].…”

Case report on bilateral emphysematous pyelonephritis in a non-diabetic male: A complex treatment journey

“…According to this classification system, the case in question is categorized as Class IV. In this system, Class IV corresponds to “Class 4 – Bilateral EPN or EPN in a solitary kidney [ 16 ]”.…”

Performance of Scoring Systems in Predicting Clinical Outcomes of Patients with Emphysematous Pyelonephritis: A 14-Year Hospital-Based Study

“…Not only the risk factors but also the scoring systems should be taken into consideration when deciding the most suitable treatment. In the literature review, Chawla et al analyzed 90 consecutive patients and found that the NEWS scoring system was best able to predict the requirement of ICU care [24]. Krishnamoorthy et al described that the objective and qualitative risk stratification assessment is necessary for treating patients with EPN [25].…”