title: Serious acute pyelonephritis: a predictive score for evaluation of deterioration of treatment based on clinical and radiologic findings using CT.
abstract: BACKGROUND
  Acute pyelonephritis (APN) requires prompt diagnosis and immediate treatment.
  
  
  OBJECTIVE
  To develop a simple score to assist in diagnosing treatment deterioration in patients with serious APN.
  
  
  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 score was 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).
  
  
  CONCLUSIONS
  This easy-to-calculate score may prove useful for diagnosing patients with serious APN who deteriorate with treatment.
authors.affiliation: Department of Radiology, Keimyung University, Dongsan Hospital, Daegu, Korea. kseehdr@dsmc.or.kr
authors.forename: See Hyung
authors.initials: SH
authors.lastname: Kim
authors.forename: Young Whan
authors.initials: YW
authors.lastname: Kim
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011704:Pyelonephritis / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media