title: A risk stratification model of acute pyelonephritis to indicate hospital admission from the ED.
abstract: OBJECTIVE
  There are no guidelines regarding the hospitalization of female patients with acute pyelonephritis (APN); therefore, we performed a retrospective analysis to construct a clinical prediction model for hospital admission.
  
  
  METHODS
  We conducted a retrospective analysis of a prospective database of women diagnosed as having APN in the emergency department between January 2006 and June 2012. Independent risk factors for admission were determined by multivariable logistic regression analysis in half of the patients in this database. The risk of admission was categorized into 5 groups. The internal and external validations were conducted using the remaining half of the patients and 192 independent patients, respectively.
  
  
  RESULTS
  Independent risk factors for admission were age of 65 years or greater (odds ratio [OR], 2.62; 1 point), chill (OR, 2.40; 1 point), and the levels of segmented neutrophils greater than 90% (OR, 2.00; 1 point), serum creatinine greater than 1.5 mg/dL (OR, 2.41; 1 point), C-reactive protein greater than 10 mg/dL (OR, 2.37; 1 point), and serum albumin less than 3.3 g/dL (OR, 7.36; 2 points). The admission risk scores consisted of 5 categories, which were very low (0 points; 5.9%), low (1 point; 10.7%), intermediate (2 points; 20.7%), high (3-4 points; 51.9%), and very high (5-7 points; 82.8%) risk, showing an area under the curve of 0.770. The areas under the curve of the internal and external validation cohorts were 0.743 and 0.725, respectively.
  
  
  CONCLUSIONS
  This model can provide a guideline to determine the admission of women with APN in the emergency department.
authors: Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors: Changwoo
authors: C
authors: Kang
authors: Kyuseok
authors: K
authors: Kim
authors: Soo Hoon
authors: SH
authors: Lee
authors: Chanjong
authors: C
authors: Park
authors: Joonghee
authors: J
authors: Kim
authors: Jae Hyuk
authors: JH
authors: Lee
authors: You Hwan
authors: YH
authors: Jo
authors: Joong Eui
authors: JE
authors: Rhee
authors: Dong Hoon
authors: DH
authors: Kim
authors: Seong Chun
authors: SC
authors: Kim
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D011704:Pyelonephritis / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers