Emphysematous Pyelonephritis: A Correlation of Clinical Characteristics With Serum Parameters and Its Contribution in Determination of Prognostic Factors

Abstract

Background: Emphysematous pyelonephritis (EPN) is a severe lifethreatening infection of renal parenchyma, peri-renal tissue and collecting system primarily caused by gas forming bacteria and carries a significant mortality of 80% when primarily treated non-surgically. Early identification of the disease process along with timely surgical management is of paramount significance. In the last 2 decades evolution of surgical management has lead to a substantial decrease in mortality of up to 21%. The focus of the present study was to investigate optimal serum panel parameters and to propagate prognostic model for the optimal evaluation management of EPN. Methods: The present study was conducted at the Department of Urology at GMCH, Gauhati. Authors retrospectively analyzed all clinical, laboratory and radiological data along with outcome of 44 patients with EPN from January 2015 to August 2017. Chi-square analysis and Spearman tests were used to carve out significant association and correlation. Results: The overall survival rate was 86.37% (38/44). Escherichia coli (E.Coli) was the most common bacterial pathogen isolated from urine and pus culture. Uncontrolled type 2 diabetes mellitus (DM), polymicrobial infection, shock, thrombocytopenia, bacteremia, hypoalbuminemia, and hemodialysis were significantly more common in cases of death and correlated with adverse serum profile. The AUC of the ROC curve for the seven prognostic factors was 0.59 and only thrombocytopenia (TCP) (AUC = 0.78, P = 0 .033) along with liver cirrhosis (AUC = 0.76, P = 0.018) came out to be significant post ROC analysis. Conclusions: Upfront clinical factors such as uncontrolled DM type 2, polymicrobial infection, shock, thrombocytopenia, bacteremia, hy-poalbuminemia, hemodialysis along with altered serum parameters are significantly correlated with outcome in patients of EPN.