J Korean Soc Emerg Med.  2018 Jun;29(3):259-266. 10.0000/jksem.2018.29.3.259.

The clinical usefulness of computed tomography findings as a prognostic factor for patients with acute pyelonephritis in emergency department

• Lee BG
• Kim JW
• Lee KR
• Hong DY
• Baek KJ
• Park SO
• Kim SY
• Kim JY

• KMID: 2435510
• DOI: http://doi.org/10.0000/jksem.2018.29.3.259

Abstract

OBJECTIVE
This study examined the efficacy of the computed tomography (CT) findings in the emergency department (ED) in predicting the clinical course and severity of acute pyelonephritis (APN).
METHODS
This retrospective clinical study included APN patients in the ED. All participants diagnosed with APN had undergone a radiocontrast-enhanced CT evaluation. The radiocontrast-enhanced CT findings of APN revealed the typical findings, such as hypoperfusion on the kidney, extra-renal parenchymal findings, and renal abscess formation. The patients were classified into five groups based on the CT findings. The clinical parameters analyzed were the white blood cell (WBC) count, C-reactive protein (CRP) level, quick sepsis-related organ failure-assessment (qSOFA) score, need for vasopressor, length of stay, and admission to the intensive care unit (ICU). The relationships between the clinical parameters and the five groups based on the APN CT findings were assessed.
RESULTS
Among the 264 patients, there were 225 female patients and the mean age of all patients was 57.9±20.5 years: group 1 (n=31), present renal abscess with APN; group 2 (n=118), both typical and extra-renal parenchymal findings; group 3 (n=49), only typical finding; group 4 (n=32), only extra-renal parenchymal findings; and group 5 (n=34), no APN finding on CT. The length of stay increased from groups 5 to 1. The WBC count and CRP level were worsen from groups 4 to 1, except for group 5. Statistically significant trends, such as the WBC count, CRP level and length of stay correlated with each group were observed (P < 0.001, P < 0.001, and P < 0.001). Statistically significant trends in ICU admission, use of vasopressor, and qSOFA score were also observed (P=0.022, P=0.003, and P < 0.001).
CONCLUSION
The specific CT findings of APN might be helpful for predicting the clinical severity and prognosis.

Keyword

Pyelonephritis; Spiral computed tomography; Prognosis

MeSH Terms

Abscess
C-Reactive Protein
Clinical Study
Emergencies*
Emergency Service, Hospital*
Female
Humans
Intensive Care Units
Kidney
Length of Stay
Leukocytes
Prognosis
Pyelonephritis*
Retrospective Studies
Tomography, Spiral Computed
C-Reactive Protein