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

Abstract

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, Body Mass Index (BMI), EPN type, the organism causing infection and biochemical variables were registered. We 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 leucocytic count (P<0.001), higher lymphocytic count (P<0.001) and lower PLR (P<0.001). Multivariate regression analysis revealed that the main risk factors of urosepsis were the leukocytic (OR:85.7 ; IC 95% : 9.177–800.486 ; P<0.001) and lymphocytic count (OR:6.65 ; IC 95% : 1.228–36.050 ; P=0.028). Neither of variables was significantly associated with higher risk of mortality. Conclusion: Leucocytic and lymphocytic count on admission are independent simple predictors for sepsis in patients with EPN.

Report on the diagnosis and treatment of 3 cases of emphysematous pyelonephritis with two different outcomes

“…EPN is a life-endangering suppurative infection of the renal parenchyma and perirenal tissue ( 7 ), Its mortality rate up to 78% in 1970s ( 10 ). Recently, many reports indicated a decrease in mortality rates, ranging from 11 to 42% ( 11 , 12 ). Its mortality rate is related to many factors, including thrombocytopenia, altered sensorium and/or shock at initial presentation, as well as polymicrobial infections ( 13 ).…”