title: Scoring system development and validation for initial treatment failure in suppurative kidney infections.
abstract: BACKGROUND
  Suppurative kidney infections (SKIs) have potentially lethal implications and a high incidence of treatment-related morbidity and death. Until this point, there has been no study that has derived a prognostic model for adverse early outcomes in SKI. Therefore, our aim was to derive and validate a simple scoring system of early treatment failure in SKI.
  
  
  METHODS
  Logistic regression and bootstrap methods were used to create an integer score for estimating the risk of early treatment failure using patient characteristics, severity of disease, bacterial etiology, type of pathology, initial antibiotic therapy, and early urologic procedures.
  
  
  RESULTS
  This study included 92 adult patients with 104 SKIs. Early treatment failure was observed in 57 patients (54.8%). The length of the hospital stay and the treatment complications were significantly longer and more common, respectively, in patients with early treatment failure. The factors associated most strongly with early treatment outcome were whether there had been an early complete urologic procedure, the adequacy of early antibiotic therapy, and the presence or absence of sepsis syndrome. The total possible score ranged from 0 to 22 points, with a cut-off value of 5 points. A score of ≤ 5 points identified early success correctly in 85.3% of patients, whereas a score > 5 points correctly identified early failure in 93.2%. The scoring system retained its predictive ability on the validation set.
  
  
  CONCLUSIONS
  A scoring system was created to predict early treatment failure for a given patient with SKI. Although the system has good performance characteristics and provides a possible intervention measure, further studies should be performed before widespread implementation.
authors.affiliation: Department of Urology, Clinic of Urology and Nephrology, Clinical Centre Kragujevac, Kragujevac, Serbia. midinac@EUnet.rs
authors.forename: Miroslav M
authors.initials: MM
authors.lastname: Stojadinović
authors.forename: Dragan R
authors.initials: DR
authors.lastname: Milovanović
authors.forename: Branko S
authors.initials: BS
authors.lastname: Gajić
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D003950:Diagnostic Techniques, Urological; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013492:Suppuration; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents