Sriram Krishnamoorthy1, Alimuddin Zumla2,3, Hariharasudhan Sekar1, Asif Muneer4, Gayathri Thiruvengadam5, Natarajan Kumaresan1. 1. Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai, India. 2. Division of Infection and Immunity, Centre for Clinical Microbiology, University College London (UCL), London,, UK. 3. UK National Institute for Health Research (NIHR) Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK. 4. Division of Surgery and Interventional Science UCL, Department of Urology and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK. 5. Department of Bio-Statistics, Faculty of Allied Health Science, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.
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.
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.
Authors: Xuan Thai Ngo; Tuan Thanh Nguyen; Ryan W Dobbs; Minh Sam Thai; Duc Huy Vu; Le Quy Van Dinh; Khoa Quy; Hieu Trong Le; Tien-Dat Hoang; Hanh Thi Tuyet Ngo; Trinh Ngoc Khanh Van; Ho Yee Tiong; Huy Gia Vuong Journal: World J Surg Date: 2022-07-08 Impact factor: 3.282
Authors: Arun Chawla; Sunil Pillai Bhaskara; Ravi Taori; Jean J M C H de la Rosette; Pilar Laguna; Akhilesh Pandey; Sitaram Mummalaneni; Padmaraj Hegde; Shwetapriya Rao; Prakashini K Journal: Ther Adv Urol Date: 2022-02-22