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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

Krishnamoorthy, S; Zumla, A; Sekar, H; Muneer, A; Thiruvengadam, G; Kumaresan, N; (2020) Prognostic scoring system and risk stratification in patients with emphysematous pyelonephritis: an 11‐year prospective study at a tertiary referral centre. BJU International 10.1111/bju.15225. Green open access

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Abstract

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 January 2009 to December 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 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. / Results: Data from 131 patients with EPN enrolled in the study were analysed: Group 1 (n = 22), Group 2 (n = 102) and Group 3 (n = 7). By using univariate analysis, 10 factors were identified to be significantly associated with prognosis. Diabetes mellitus was the most common comorbidity. 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.

Type: Article
Title: Prognostic scoring system and risk stratification in patients with emphysematous pyelonephritis: an 11‐year prospective study at a tertiary referral centre
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/bju.15225
Publisher version: https://doi.org/10.1111/bju.15225
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: diabetes mellitus, emphysematous pyelonephritis, haemodialysis, percutaneous nephrostomy, nephrectomy, #UroUTI
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/10119706
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