Prognostic scoring system and risk stratification in patients with emphysematous pyelonephritis: an 11‐year prospective study at a tertiary referral centre

Krishnamoorthy, Sriram; Zumla, Alimuddin; Sekar, Hariharasudhan; Muneer, Asıf; Thiruvengadam, Gayathri; Natarajan, K

doi:10.1111/bju.15225

Cited by 10 publications

(20 citation statements)

References 30 publications

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“…This too focused more on mortality rates and was not externally validated. 11 The present work in this large cohort of patients with EPN attempts to identify the best approach to evaluating and triaging these critically sick patients, to expedite their care using MEWS, NEWS, SOFA, qSOFA and SIRS. In our study, all the predictive clinical scoring systems performed well, each achieving AUC > 0.7.…”

Section: Discussionmentioning

confidence: 99%

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

Chawla

Bhaskara

Taori

et al. 2022

Therapeutic Advances in Urology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Chawla

Bhaskara

Taori

et al. 2022

Therapeutic Advances in Urology

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“…PCN is part of the initial treatment in patients with emphysematous pyelonephritis [ 9 ]. The PCN was used in most of our patients to relieve obstruction (renal calculi, pregnancy-related hydronephrosis, and pyonephrosis) and obtain access to the renal system (removal of forgotten stents and percutaneous nephrolithotomy) [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Nephrostomy in Complicated Urinary Tract Infections

Mondal¹,

Viswanathan²,

Kodakkattil³

2022

Cureus

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BackgroundThe study aimed to determine the various indications for percutaneous nephrostomy (PCN) primarily in patients with a urinary tract infection and to determine the various complications arising in these patients due to the procedure. Materials and methodsA retrospective study of five-year data based on registers of the Department of Urology was performed. Among 716 patients, 226 inpatient data were obtained, curated, and analyzed. Indications for PCN, the periprocedural complications, the PCN's duration, details of antibiotics, risk factors for UTI, development of acute kidney injury, and renal replacement therapy were recorded. ResultsPatients were mostly female (53.1%, n=120/226). Malignancy (n=109, carcinoma cervix=68/109) and nephrolithiasis (n=70) contributed to 79.2%. Infections such as pyelonephritis, renal abscess, perinephric abscess, and genitourinary tuberculosis were identified in 47. Infectious diseases were significantly associated with younger age, female gender, diabetes, and prior pyelonephritis. PCN was placed at a median of two days after admission, and bilateral PCN was placed in 36 (15.2%) patients. Hydroureteronephrosis (probably infected) was an indication for PCN in 164/226 patients. In 33 patients with an infectious disease, PCN was performed for an obstructed urinary system. One major and two minor complications gave a rate of 0.06% for patients with infections, which was less than the accepted threshold of 4%. ConclusionsWe intended to study the utility and problems with placing a PCN catheter in patients with complicated urinary infections. We conclude that PCN is a safe and effective procedure in urinary tract infections with obstructed drainage.

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Hsieh

et al. 2022

JCM

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Background: Emphysematous pyelonephritis (EPN) is a rare but severe necrotizing infection causing there to be gas in the pelvicalyceal system, renal parenchyma, and perirenal or pararenal space. Physicians should attend to EPN because of its life-threatening septic complications. The overall mortality rate has been reported to be as high as 20–40%. In addition, most patients had diabetes mellitus (DM) and obstructive uropathy. The most common isolated microorganism is Escherichia coli. This study aims to analyze the risk factors and performance of scoring systems in predicting the clinical outcomes of patients with EPN. Materials and Methods: We collected the data of patients with EPN in this single hospital-based retrospective study from the electronic medical records of Taichung Veterans General Hospital between January 2007 and December 2020. Radiological investigations of abdominal computed tomography (CT) confirmed the diagnosis of EPN. In addition, we analyzed demographics, clinical characteristics, and laboratory data. Finally, we used various scoring systems to predict clinical outcomes. Results: A total of fifty patients with EPN, whose diagnoses were confirmed through CT, were enrolled in the study. There were 18 males (36%) and 32 females (64%), with a mean age of 64.3 ± 11.3 years. The in-hospital mortality rate was 16%. A DM of 34 (68%) patients was the most common comorbidity. Fever was the most common symptom, found in 25 (50%) patients. The Mortality in Emergency Department Sepsis (MEDS) score was 4.64 ± 3.67 for survivors and 14.25 ± 5.34 for non-survivors (p < 0.001). The National Early Warning Score (NEWS) was 3.64 ± 2.33 for survivors and 7.13 ± 4.85 for non-survivors (p = 0.046). The Rapid Emergency Medicine Score (REMS) was 5.81 ± 1.97 for survivors and 9.13 ± 3.87 for non-survivors (p = 0.024). Regarding performance of mortality risk prediction, the AUC of ROC was 0.932 for MEDS, 0.747 for REMS, and 0.72 for NEWS. Conclusions: MEDS, REMS, and NEWS could be prognostic tools for the prediction of the clinical outcomes of patients with EPN. MEDS showed the best sound performance. In those with higher scores in MEDS (≥12), REMS (≥10), and NEWS (≥8), we recommended aggressive management and appropriate antimicrobial therapy as soon as possible to reduce mortality. Further large-scale studies are required to gain a deep understanding of this disease and to ensure patient safety.

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Prognostic scoring system and risk stratification in patients with emphysematous pyelonephritis: an 11‐year prospective study at a tertiary referral centre

Cited by 10 publications

References 30 publications

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

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

Percutaneous Nephrostomy in Complicated Urinary Tract Infections

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

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