Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jun 25, 2025; 14(2): 103035
Published online Jun 25, 2025. doi: 10.5527/wjn.v14.i2.103035
Modified National Early Warning Score 2, a reliable early warning system for predicting treatment outcomes in patients with emphysematous pyelonephritis
Sriram Krishnamoorthy, Gayathri Thiruvengadam, Hariharasudhan Sekar, Velmurugan Palaniyandi, Srinivasan Ramadurai, Senthil Narayanasamy
Sriram Krishnamoorthy, Hariharasudhan Sekar, Velmurugan Palaniyandi, Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
Gayathri Thiruvengadam, Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
Srinivasan Ramadurai, Senthil Narayanasamy, Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, Tamil Nādu, India
Author contributions: Krishnamoorthy S played a major role in the study by conceiving the idea, designing the research framework, and writing the full manuscript; Thiruvengadam G performed the statistical analysis, contributed to manuscript writing, and played a key role in the study's execution; Sekar H, Palaniyandi V, Ramadurai S, and Narayanasamy S were responsible for data collection and management of patients; all authors reviewed, revised, and approved the final manuscript.
Institutional review board statement: No. IEC-NI/13/OCT/36/78 enclosed as attachment.
Clinical trial registration statement: Clinical Trial Registration Statement This study was not a clinical trial and, therefore, does not require registration in a clinical trial database. It is a prospective observational study based on anonymized patient records and involves no prospective interventional procedures. Author Certification By signing below, I confirm that: (1) The clinical trial registration details provided above are accurate and comply with journal policies and international guidelines; (2) If the study does not require registration, the justification provided is valid based on its observational nature; and (3) All authors have reviewed and approved this declaration. Declaration: By signing below, I confirm that the information provided in this Clinical Trial Registration Statement is accurate and aligns with the policies of our institution and journal requirements. Corresponding Author Name: Sriram Krishnamoorthy. Date: 20th February 2025.
Informed consent statement: Informed consent was not required for this study as it is a prospective analysis utilizing anonymized patient data from medical records, with no direct patient interaction or intervention. The study was conducted in accordance with institutional ethical guidelines and regulatory standards for observational research, ensuring patient confidentiality and data protection.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to ethical and institutional regulations, access to patient-specific data is restricted to ensure confidentiality and compliance with data protection policies.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sriram Krishnamoorthy, Professor, Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education and Research, 1 Ramachandra Nagar, Porur, Chennai 600116, Tamil Nādu, India. sriramuro@gmail.com
Received: November 6, 2024
Revised: February 21, 2025
Accepted: March 4, 2025
Published online: June 25, 2025
Processing time: 154 Days and 20.7 Hours
Abstract
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 (P < 0.01). All patients managed conservatively belonged to group 1 (P < 0.01). Eight patients underwent early nephrectomy, with six from group 3 (P < 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 P < 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.

Keywords: Pyelonephritis; Emphysematous; Nephrectomy; National Early Warning Score 2; Mortality

Core Tip: We present the most extensive single-centre study on patients diagnosed with emphysematous pyelonephritis (EPN), comprehensively evaluating risk stratification, disease severity, and treatment outcomes. While the traditional National Early Warning Score 2 (NEWS 2) score is a well-established tool for triaging critically ill patients in emergency settings, its ability to predict long-term treatment outcomes in EPN remains limited. The modified NEWS 2 score proposed in this study enhances risk differentiation, allowing for more accurate prognostication and timely clinical decision-making. This refined scoring system enables optimized resource allocation, early intensive care unit admission, and tailored treatment approaches, ultimately improving patient survival and reducing morbidity in EPN.