Prevalence and Risk Factors of Mortality in Emphysematous Pyelonephritis Patients: A Meta-Analysis

Risk factors for sepsis and mortality in patients with emphysematous pyelonephritis : a series of 68 cases (case series)

Background

Emphysematous pyelonephritis (EPN) is a rare and severe necrotizing infection of the kidney with a high rate of complications and mortality. Our aim was to investigate risk factors of urosepsis and mortality in case of EPN.

Materials and methods

Between January 2010 and December 2022 the charts of patients diagnosed with EPN were retrospectively reviewed. Patients medical records were collected and data including demographics, BMI, EPN type, the organism causing the infection and biochemical variables were registered. The authors performed an univariate and multivariate logistic regression analysis for sepsis, septic shock, and mortality. Statistical significance was defined as a P-value of <0.05.

Results

Our study included 68 patients (63% females, mean age 58.6 years old). Forty-eight patients (70.6%) had diabetes. Half of the patients (50%) presented with sepsis and 11 patients (16.2%) developed a septic shock. The following factors were associated with sepsis by univariate analysis: diabetes (P=0.01), higher blood sugar on admission (P=0.01), higher leukocytic count (P<0.001), higher lymphocytic count (P<0.001), and lower platelet to leukocytes ratio (P<0.001). Multivariate regression analysis revealed that the main risk factors of urosepsis were the leukocytic (OR: 85.7; 95% CI: 9.177-800.486; P<0.001) and lymphocytic count (OR: 6.65; 95% CI: 1.228-36.050; P=0.028). Neither of the variables was significantly associated with a higher risk of mortality.

Conclusion

Leukocytic and lymphocytic count on admission are independent simple predictors for sepsis in patients with EPN.

An Atypical Presentation of Emphysematous Pyelonephritis Complicated by Methicillin-Resistant Staphylococcus aureus Bacteremia

Emphysematous pyelonephritis is an acute necrotizing infection of the renal parenchyma, collecting system, and surrounding perinephric tissue, characterized by the presence of gas within these locations on imaging. It is associated with high mortality rates and is often found in diabetic patients. We present the case of a 60-year-old female, with a past history of Von Willebrand disease and hypertension, who presented to our emergency department complaining of acute-on-chronic right knee, left hip, and paraspinal lumbar back pain with an increased frequency of falling for approximately one week. She was found to have pursed-lip breathing on physical exam. Due to her vague clinical presentation, this condition was incidentally discovered on initial workup for a pulmonary embolus, found to have extensive air in the left renal collecting system on CT of the chest. Broad-spectrum antibiotics and monitoring of hemodynamics were part of the initial resuscitation with eventual percutaneous nephrostomy tube placement by interventional radiology. Post-operatively, she developed acute respiratory distress syndrome further complicated by methicillin-resistant Staphylococcus aureus bacteremia. It is important to keep emphysematous pyelonephritis in the differential even in the absence of risk factors and signs of urosepsis when a patient presents with vague signs and symptoms of this disease.

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

INTRODUCTION

Our study aimed to evaluate the performance of Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Systemic Inflammatory Response Syndrome (SIRS), and Global Research in the Emphysematous Pyelonephritis group (GREMP) in predicting the need of admission in intensive care units (ICU) for emphysematous pyelonephritis (EPN) patient.

PATIENTS AND METHODS

In this retrospective study, we reviewed 70 patients admitted to our department from January 2008 to October 2022. Data on clinical presentation and EPN management were noted. The five scoring systems were calculated by one investigator. Univariate and multivariate analyses were used to assess predictive factors of severe sepsis and mortality. Statistical analysis was made using SPSS version 22.

RESULTS

Mean age was 61.83 years with 65.7% diabetes. As per Huang and Tseng classification, 41 patients had class I EPN, 7 had class II EPN, 8 had class IIIa, 6 class IIIB EPN, and 8 had class IV EPN. Seventeen patients (24.28%) were admitted to ICU with an 18.57 mortality rate. Univariate analysis showed that ICU admission was significantly associated with higher respiration rate and heart rate, lower systolic blood pressure, confusion, CRP, lactate and creatinine serum (p = 0.0001, p = 0.0001, p = 0.001, p = 0.007, p = 0.004, p = 0.001, p = 0.001, respectively). All five scores and Huang and Tseng classification were significantly predictive of admission to ICU. All five scores showed good results under the area curves to predict ICU entry with 0.915, 0.895, 0.968, 0.887, and 0.846 for qSOFA, MEWS score, NEWS score, SIRS, and GREMP score, respectively.

CONCLUSION

NEWS score seemed to be the best performing physiologic score among the five scoring systems studied and may help with biological and radiological findings to quickly identify EPN patients that need intensive care unit.

Sepsis caused by emphysematous pyelonephritis: A case report

Purpose

Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing renal parenchymal infection. It is most commonly reported in patients with poor glycemic control.

Patient concerns

We report the case of a 64-year-old woman who presented to the emergency room with fever and weakness over the last few days.

Diagnosis

After a series of tests in the diagnostic workup, the patient was diagnosed with emphysematous pyelonephritis and sepsis.

Intervention and outcome

She received conservative treatment with meropenem and symptomatic treatment, and the symptoms improved significantly.

Lessons

EPN can be reliably diagnosed using non-contrast abdominal CT imaging. The infection is most commonly caused by the Escherichia coli species, and a good curative effect can be achieved with early diagnosis and appropriate and timely treatment.

Successful nephrectomy after a failure of non-surgical treatment in emphysematous pyelonephritis: A case report

Emphysematous pyelonephritis (EP) is an uncommon condition involving acute severe necrotising infection in the renal parenchyma, perinephric space and collecting system, with a mortality rate of up to 13%. A 62-year-old male with poorly controlled diabetes mellitus presented with severe epigastric pain and shortness of breath for three days. A computed tomography scan revealed class 3B EP, which failed medical therapy and percutaneous drainage. He underwent a nephrectomy and achieved an excellent clinical recovery. Septic shock and uncontrolled diabetes mellitus are two risk factors that lead to a poorer prognosis. Class 3B EP with failed medical therapy and percutaneous drainage would benefit from nephrectomy.