Serious acute pyelonephritis: a predictive score for evaluation of deterioration of treatment based on clinical and radiologic findings using CT
- 김시형; 김영환; 이희정
- Alternative Author(s)
- Kim, See Hyung; Kim, Young Hwan; Lee, Hee Jung
- Publication Year
- Background: Acute pyelonephritis (APN) requires prompt diagnosis and immediate treatment.
Purpose: To develop a simple score to assist in diagnosing treatment deterioration in patients with serious
Material and Methods: Using data from a retrospective cohort of 193 patients with APN, we developed
scores based on multivariate logistic regression after the jackknife procedure. We validated the scores in a
prospective cohort of 40 patients.
Results: Nine criteria were independently associated with our investigation: Abscess (adjusted odds ratio
[OR], 19.8; 95% confidence interval [95% CI] 4.5–72.1), pyonephrosis with or without stone (18.3; 4.8–70.9),
pelvicalyceal air (15.5; 3.2–26.9), poor global excretion of contrast (12.3; 2.9–68.5), tachycardia or hypotension
(10.1; 2.5–28.0), obliteration of the renal sinus (9.6; 2.5–45.2), persistent fever or pyuria (9.8; 1.9–25.8),
diabetes (9.4; 2.0–31.8), and global renal enlargement (7.5; 2.1–35.8). The APN scorewas based on these nine
criteria. Low-risk and high-risk groups were derived from the score (probability, 3.5% [95% CI 0–7.5] and
67% [51–83]). Application of these criteria to the prospective cohort confirmed the diagnostic accuracy of
the score (probability 0% [0–15] and 71% [25–100] in the low-risk and high-risk groups, respectively).
Conclusion: This easy-to-calculate score may prove useful for diagnosing patients with serious APN who
deteriorate with treatment.
Keywords: Acute pyelonephritis (APN), CT, jackknife procedure
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