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Ma LP, Zhou N, Fu Y, Liu Y, Wang C, Zhao B. Emphysematous pyelonephritis: Six case reports and review of literature. World J Clin Cases 2022; 10:3268-3277. [PMID: 35647118 PMCID: PMC9082711 DOI: 10.12998/wjcc.v10.i10.3268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/11/2022] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a severe acute necrotizing infection of the renal parenchyma and surrounding tissues that causes the presence of gas in the renal parenchyma, collecting system, or perinephric tissue and has a poor prognosis. EPN occurs primarily in people with diabetes mellitus (DM), but can occur in those without DM when the associated renoureteral unit is obstructed.
CASE SUMMARY We describe our experience with six patients who developed EPN. Five patients had DM, including one with diabetic ketoacidosis, one with multisystem involvements, including eye, lung and brain. Bilateral urolithiasis was present in one case, along with emphysematous cystitis. Unilateral kidney stones were present in one patient. One patient was an older man in poor general health. Five individuals survived and underwent surgical procedures including ureteral stent installation (Double J stent placement), percutaneous nephrostomy and perinephric abscess puncture drainage, while one died because the patient’s family chose to terminate therapy. Klebsiella pneumoniae and Escherichia coli were the microorganisms implicated.
CONCLUSION We conclude that EPN is a potentially fatal illness. A positive outcome necessitates early detection. Therapeutic measures should be implemented as soon as a diagnosis is made.
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Affiliation(s)
- Li-Ping Ma
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Ning Zhou
- Department of Urology Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Yan Fu
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Yan Liu
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Cong Wang
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Bin Zhao
- Department of Emergency, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
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Chávez-Valencia V, Orizaga-de-La-Cruz C, Aguilar-Bixano O, Lagunas-Rangel FA. Coexistence of emphysematous cystitis and bilateral emphysematous pyelonephritis: a case report and review of the literature. CEN Case Rep 2020; 9:313-317. [PMID: 32328853 DOI: 10.1007/s13730-020-00479-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/12/2020] [Indexed: 01/04/2023] Open
Abstract
Emphysematous pyelonephritis (EPN) is a necrotizing infection characterized by the production of gas in the renal parenchyma, collecting system or perirenal tissue. Meanwhile, emphysematous cystitis (EC) is a clinical entity characterized by the presence of gas inside and around the bladder wall. Interestingly, although both diseases are common in patients with diabetes mellitus, these are rarely combined. We report a rare case of a 56-year-old diabetic male suffering from fever, headache and vomiting and in which a diagnosis of septic shock was established due to coexistence of EC and bilateral EPN. The emphysematous diseases improved with a conservative treatment approach using antibiotic therapy and glycemic control, we highlight that the nephrectomy was not necessary in our patient despite the fact that he presented risk factors that predict the failure of conservative treatment.
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Affiliation(s)
- Venice Chávez-Valencia
- Department of Nephrology, Hospital General Regional Hospital No 1, Instituto Mexicano del Seguro Social, Bosques de los Olivos No. 101. Av. La Goleta Mpo Charo, CP: 61301, Morelia, Michoacán, Mexico.
| | - Citlalli Orizaga-de-La-Cruz
- Department of Nephrology, Hospital General Regional Hospital No 1, Instituto Mexicano del Seguro Social, Bosques de los Olivos No. 101. Av. La Goleta Mpo Charo, CP: 61301, Morelia, Michoacán, Mexico
| | - Omar Aguilar-Bixano
- Department of Nephrology, Hospital General Regional Hospital No 1, Instituto Mexicano del Seguro Social, Bosques de los Olivos No. 101. Av. La Goleta Mpo Charo, CP: 61301, Morelia, Michoacán, Mexico
| | - Francisco Alejandro Lagunas-Rangel
- Department of Genetics and Molecular Biology, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV), Mexico, Mexico
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Punatar C, Jadhav K, Kumar V, Joshi V, Sagade S. Neutrophil:Lymphocyte Ratio as a Predictive Factor for Success of Nephron-Sparing Procedures in Patients with Emphysematous Pyelonephritis. Perm J 2019; 23:18-044. [PMID: 30624199 DOI: 10.7812/tpp/18-044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We studied the value of neutrophil:lymphocyte ratio (NLR) in predicting the success of nephron-sparing procedures in management of emphysematous pyelonephritis. METHODS In this single-center retrospective study, patients underwent nephron-sparing procedures between 2007 and 2014. Severity was graded by Huang-Tseng classification. Thrombocytopenia, acute renal failure (ARF), shock, altered sensorium, and admission NLR were evaluated for predictive value for successful outcomes. Receiver operating characteristic curves were plotted to determine optimal cutoff of NLR for differentiating successful and unsuccessful outcomes. Two-sided p values were calculated with the χ2 test. Factors that were significant on univariate analysis were combined in a model with NLR. RESULTS Sixteen patients, 14 (87.5%) of whom were female and 14 (87.5%) of whom had diabetes, were included. Ten (63%) had severe emphysematous pyelonephritis. The optimal cutoff of NLR was 5. Four (44%) of 9 patients with NLR above 5 had unfavorable outcomes compared with none of 7 with NLR of 5 or less, giving a risk ratio of 1.8 (95% confidence interval [CI]= 1.01-3.22, p = 0.0417). Area under the curve for NLR alone was 0.77 (95% CI = 0.55-0.99, p = 0.014). High NLR and ARF were the only factors predicting unsuccessful outcome (p = 0.0417 each). When these were combined in a model (NLR as continuous variable), the area under the curve increased to 0.92. CONCLUSION NLR is a useful predictive marker in emphysematous pyelonephritis. Its predictive value increases when combined with presence or absence of ARF. In patients with high NLR and ARF, the threshold for considering nephrectomy should be low.
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Affiliation(s)
- Chirag Punatar
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharshtra, India
| | - Kunal Jadhav
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharshtra, India
| | - Vikash Kumar
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharshtra, India
| | - Vinod Joshi
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharshtra, India
| | - Sharad Sagade
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharshtra, India
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Karthikeyan VS, Manohar CMS, Mallya A, Keshavamurthy R, Kamath AJ. Clinical profile and successful outcomes of conservative and minimally invasive treatment of emphysematous pyelonephritis. Cent European J Urol 2018; 71:228-233. [PMID: 30038815 PMCID: PMC6051364 DOI: 10.5173/ceju.2018.1639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/01/2018] [Accepted: 04/12/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is a rare clinical entity, characterized by gas in the renal system, due to an acute, fulminant and potentially fatal necrotizing process with varying clinical presentations. It is much more aggressive than uncomplicated pyelonephritis, with the mortality of 20-40% in the contemporary meta-analysis. MATERIAL AND METHODS A retrospective record review of inpatients at the Institute of Nephro Urology, Bangalore, India (2007-2014), who were treated after EPN was diagnosed with the aid of a CT (computed tomography) scan. RESULTS Sixty-six patients (M:F 27:39) treated for EPN over the past seven years with the mean (±SD) age of 52.32 (±12.48) years were analyzed. Median (interquartile range) duration of hospital stay was 8 (11.25) days with 4 (6%) patients requiring intensive care unit admission (median, IQR = 5.5, 1.5 days) of whom two passed away due to septicemia. Fifty-six (84.85%) patients were diabetics, forty (60.6%) patients had estimated glomerular filtration rate (eGFR) <60 ml/min/1.7 3 m2, 6 (9.1%) patients had eGFR <30 ml/min/1.73 m2 including 3 (4.5%) with eGFR <15 ml/min/1.73 m2 requiring hemodialysis and twenty-two (33%) had thrombocytopenia. Fifty (75.76%) patients were classified as Huang and Tseng Class 2, 7 (10%) as Class 3 with perinephric abscess requiring open drainage and 9 (13.64%) had bilateral EPN (Class 4). Majority (43; 65%) responded to piperacillin-tazobactam treatment. Double J stenting was done in 17 (25.76%) patients, percutaneous drainage in 5 (7.58%) patients and nephrectomy in 2 (3%) patients. CONCLUSIONS Although EPN historically carries high morbidity and mortality, modern day medical management with timely intervention in the form of urinary drainage is effective and curative in most patients resulting in a low mortality rate.
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Affiliation(s)
| | | | - Ashwin Mallya
- Department of Urology, Insititute of Nephro Urology, Bangalore, India
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Kang CI, Kim J, Park DW, Kim BN, Ha US, Lee SJ, Yeo JK, Min SK, Lee H, Wie SH. Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections. Infect Chemother 2018; 50:67-100. [PMID: 29637759 PMCID: PMC5895837 DOI: 10.3947/ic.2018.50.1.67] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis. This guideline targets community-acquired UTIs occurring among adult patients. Healthcare-associated UTIs, catheter-associated UTIs, and infections in immunocompromised patients were not included in this guideline.
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Affiliation(s)
- Cheol In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jieun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Baek Nam Kim
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Korea
| | - U Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jeong Kyun Yeo
- Department of Urology, Inje University College of Medicine, Pusan, Korea
| | - Seung Ki Min
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Heeyoung Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Sanford TH, Myers F, Chi T, Bagga HS, Taylor AG, Stoller ML. Emphysematous pyelonephritis: the impact of urolithiasis on disease severity. Transl Androl Urol 2016; 5:774-779. [PMID: 27785435 PMCID: PMC5071188 DOI: 10.21037/tau.2016.07.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Emphysematous pyelonephritis is a severe infection of the kidney associated with formation of gas in the renal parenchyma and/or collecting system. The purpose of this study was to evaluate outcomes of patients with emphysematous pyelonephritis in a contemporary cohort and to evaluate the impact of urolithiasis on disease severity. Methods A search of all imaging reports at University of California San Francisco (UCSF) for the term “emphysematous pyelonephritis” was undertaken from 2003–2014. Patients were included if there was clinical evidence of infection, no recent urologic instrumentation, and computerized tomography (CT) demonstrating gas in the renal parenchyma or collecting system. Clinical and laboratory variables were obtained from medical records. Results A total of 14 cases were identified. The majority of patients (57%) had gas confined to the collecting system. Three patients (21%) had gas in the renal parenchyma and 3 patients (21%) had gas extending into perirenal tissues. A total of 8 patients (57%) had concomitant urolithiasis. Seven patients (50%) were managed with antibiotic therapy alone while 6 patients (43%) required percutaneous drainage. No patients required immediate nephrectomy. There were no deaths. Patients with urolithiasis had less severe emphysematous pyelonephritis than patients without urolithiasis (P<0.05). Conclusions The majority of patients in this study had gas contained within the collecting system and were treated successfully with antibiotics alone. Percutaneous drainage was successfully utilized in patients with more advanced disease. No patients required emergent nephrectomy. Emphysematous pyelonephritis in patients with urolithiasis was less severe than in patients without urolithiasis.
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Affiliation(s)
- Thomas H Sanford
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Frank Myers
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Thomas Chi
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Herman S Bagga
- Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andrew G Taylor
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Marshall L Stoller
- Department of Urology, University of California San Francisco, San Francisco, California, USA
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Alsharif M, Mohammedkhalil A, Alsaywid B, Alhazmy A, Lamy S. Emphysematous pyelonephritis: Is nephrectomy warranted? Urol Ann 2015; 7:494-8. [PMID: 26692672 PMCID: PMC4660703 DOI: 10.4103/0974-7796.158503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is associated with high mortality rate, up to 25%. There is still conflicting reports regarding the most appropriate management, conservative versus nephrectomy. OBJECTIVE To describe the outcome of patients with EPN. METHODS We retrospectively reviewed the medical records of patients diagnosed with EPN by computed tomography from three tertiary institutes in Jeddah, Saudi Arabia. Type of management was classified as conservative and surgical. The conservative includes medical and minimally invasive procedures, such as percutaneous drainage and nephrostomy. The surgical which is nephrectomy. The outcome observed was preservation of the kidney function or patient's life. RESULTS A total of 10 patients were included (9 females and 1 male), median age was 55 years and 63% were diabetic. The most common presentation was flank pain (100%), fever (75%), and vomiting (63%). The most common organism isolated was Escherichia coli. Nephrectomy was not associated with increased survival rate, while conservative management was associated with a good outcome, less morbidity (not dialysis-dependent). CONCLUSION Nephrectomy was not associated with high survival rate. Patients managed conservatively had a better overall performance and better survival. This study will add to other studies, which are encouraging conservative management.
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Affiliation(s)
- Mada Alsharif
- Research Promotion and Education Section, King Abdullah International Research Center, Jeddah, Saudi Arabia
| | - Abdullah Mohammedkhalil
- Research Promotion and Education Section, King Abdullah International Research Center, Jeddah, Saudi Arabia
| | - Basim Alsaywid
- Research Promotion and Education Section, King Abdullah International Research Center, Jeddah, Saudi Arabia ; Department of Surgery, Urology Section, King Khalid National Guard Hospital, King Abdulaziz Medical City, Saudi Arabia ; Department of Surgery, Urology Section, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ali Alhazmy
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Salahadin Lamy
- Department of Surgery, Urology Section, King Khalid National Guard Hospital, King Abdulaziz Medical City, Saudi Arabia ; Department of Surgery, Urology Section, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, Jeddah, Saudi Arabia
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Tienza A, Hevia M, Merino I, Velis JM, Algarra R, Pascual JI, Zudaire JJ, Robles JE. Case of emphysematous pyelonephritis in kidney allograft: Conservative treatment. Can Urol Assoc J 2014; 8:E256-9. [PMID: 24839494 DOI: 10.5489/cuaj.1555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney and perinephric space that carries a bad prognosis. Apart from its predisposing clinical entities, diabetes mellitus and immune-incompetence are quite common in patients with this infection. We report a case of a 53-year-old kidney transplant recipient diabetic male, suffering from recurrent fever, abdominal pain and nausea episodes. Immediate broad-spectrum antibiotics were administered and percutaneous drainage was performed after the diagnosis. The bacteria involved were Stahpylococcus epidermidis and Escherichia coli. After 4 weeks of antibiotic treatment and abscesses drainage, the case was resolved. Consecutives urine cultures and ultrasonographies confirm the complete resolution of the disease. We discuss the predisposing factors, clinical presentation and management.
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Affiliation(s)
| | - Mateo Hevia
- Clínica Universidad de Navarra, Pamplona, Spain
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Abstract
Hepatic portal venous gas (HPVG) is an uncommon radiological sign and often portends significant underlying abdominal disease. A number of conditions may produce this sign and identifying the underlying etiology is essential for management. The advent of ultrasonography-color Doppler imaging and computerized tomography has led to more frequent recognition of this condition. This article describes the very rare association of HPVG in a patient with emphysematous pyelonephritis.
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Affiliation(s)
- Debraj Sen
- Department of Radiodiagnosis, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Arjun S Sandhu
- Department of Urology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
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Aboumarzouk OM, Hughes O, Narahari K, Coulthard R, Kynaston H, Chlosta P, Somani B. Emphysematous pyelonephritis: Time for a management plan with an evidence-based approach. Arab J Urol 2013; 12:106-15. [PMID: 26019934 PMCID: PMC4434438 DOI: 10.1016/j.aju.2013.09.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/21/2013] [Accepted: 09/22/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Emphysematous pyelonephritis (EPN) is a life-threatening necrotising kidney infection, but there is no consensus on the best management. METHODS We systematically reviewed previous articles published from 1980 to 2013 that included studies reporting on EPN, and applying the Cochrane guidelines, we conducted a meta-analysis of the results. RESULTS In all, 32 studies were included, with results for 628 patients (mean age 56.6 years, range 33.8-79.9). There were 462 women, outnumbering men by 3:1. Diabetes was present in 85% of the cases. Fevers and rigor (74.7%), pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was associated with 54.4% of deaths while obstructive uropathy was associated with 15.1% of deaths. Computed tomography was diagnostic in all the cases. Percutaneous drainage (PCD) and medical management (MM) alone were associated with a significantly lower mortality rate than was emergency nephrectomy (EN), with an odds ratio (95% confidence interval) for PCD vs. EN of 3.13 (1.89-5.16; P < 0.001), for EN vs. MM of 2.84 (1.62-4.99; P = 0.001), and of 0.91 (0.53-1.56; P = 0.73, i.e., no difference) for PCD vs. MM. Open drainage also had a significantly lower mortality rate than EN, with a ratio of 0.12 (0.02-0.91; P < 0.04). CONCLUSION The overall mortality rate was ≈18%; shock was associated with a high mortality rate and therefore should be managed aggressively. PCD and MM were associated with significantly higher survival rates than EN, and therefore EN should only be considered if the patient does not improve despite other treatments.
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Affiliation(s)
| | - Owen Hughes
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Krishna Narahari
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Richard Coulthard
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Howard Kynaston
- Department of Urology, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University, Cracow, Poland
| | - Bhaskar Somani
- Department of Urology, University Hospital of Southampton NHS Foundation Trust, Southampton, UK
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