The clinical usefulness of computed tomography findings as a prognostic factor for patients with acute pyelonephritis in emergency department.
- Author:
Byeong Geun LEE
1
;
Jong Won KIM
;
Kyeong Ryong LEE
;
Dae Young HONG
;
Kwang Je BAEK
;
Sang O PARK
;
Sin Young KIM
;
Jin Yong KIM
Author Information
1. Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Pyelonephritis;
Spiral computed tomography;
Prognosis
- MeSH:
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
- From:Journal of the Korean Society of Emergency Medicine
2018;29(3):259-266
- CountryRepublic of Korea
- Language:Korean
-
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.
