BJU Int. 2020 Sep 1. doi: 10.1111/bju.15225. Online ahead of print.
OBJECTIVES: To define pre-morbid, clinical, laboratory, and imaging features and identify prognostic factors associated with morbidity and mortality in patients with Emphysematous pyelonephritis (EPN) and develop a prognostic scoring system for improving management outcomes.
PATIENTS AND METHODS: From Jan 2009 to Dec 2019, we performed a prospective study of all patients with a suspected diagnosis of EPN referred to a specialist tertiary centre in South India. All patients who underwent non-contrast Computed tomography (CT) of the abdomen and those diagnosed with EPN were included in this study. Demographic parameters, imaging, haematological and microbiology results were recorded. Patients were divided into three groups: Group 1 - patients who survived without any intervention; Group 2 - those who survived with surgical intervention, and group 3 - those who died with or without intervention. A prognostic scoring system was developed from 18 different parameters and risk stratification was developed. The scores were correlated with overall prognosis. Data analysis was performed using IBM SPSS version 20 and STATA 14, p-value <0.05 was considered significant.
RESULTS: Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n=22); Group 2 (n=102); Group 3 (n=7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common co-morbidity. Shock at initial admission indicated a poor prognosis and warranted immediate attention (p <0.001).
CONCLUSIONS: A multi-disciplinary approach, a high index of clinical suspicion, an early diagnosis and administration of culture-specific antibiotics with identification of prognostic indicators and risk stratification allows prompt and appropriate medical and surgical treatments that could improve EPN management outcomes.