Modified National Early Warning Score 2, a reliable early warning system for predicting treatment outcomes in patients with emphysematous pyelonephritis.

BACKGROUND

Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection, predominantly affecting diabetic and immunocompromised patients. It carries high morbidity and mortality, requiring early diagnosis and timely intervention. Various prognostic scoring systems help in triaging critically ill patients. The National Early Warning Score 2 (NEWS 2) scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters, but its standard form lacks specificity for risk stratification in EPN, necessitating modifications to improve treatment decision-making and prognostic accuracy in this critical condition.

AIM

To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.

METHODS

This prospective study was done on all EPN patients admitted to our hospital over the past 12 years. A weighted average risk-stratification index was calculated for each of the three groups, mortality risk was calculated for each of the NEWS 2 scores, and the need for intervention for each of the three groups was calculated. The NEWS 2 score was subsequently modified with 0-6, 7-14 and 15-20 scores included in groups 1, 2 and 3, respectively.

RESULTS

A total of 171 patients with EPN were included in the study, with a predominant association with diabetes (90.6%) and a female-to-male ratio of 1.5:1. The combined prognostic scoring of the three groups was 10.7, 13.0, and 21.9, respectively ( < 0.01). All patients managed conservatively belonged to group 1 ( < 0.01). Eight patients underwent early nephrectomy, with six from group 3 ( < 0.01). Overall mortality was 8 (4.7%), with seven from group 3 (87.5%). The cutoff NEWS 2 score for mortality was identified to be 15, with a sensitivity of 87.5%, specificity of 96.9%, and an overall accuracy rate of 96.5%. The area under the curve to predict mortality based on the NEWS 2 score was 0.98, with a confidence interval of (0.97, 1.0) and < 0.001.

CONCLUSION

Modified NEWS 2 (mNEWS 2) score dramatically aids in the appropriate assessment of treatment-related outcomes. MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.