Al-Haggar MS, Abdelmoneim ZA. Modified National Early Warning Score 2, warning system for predicting treatment outcomes in patients with emphysematous pyelonephritis. World J Nephrol 2025; 14(3): 107879 [DOI: 10.5527/wjn.v14.i3.107879]
Corresponding Author of This Article
Zahraa A Abdelmoneim, MD, Lecturer, Department of Pediatrics, Genetics and Metabolic Unit, Mansoura University Children’s Hospital, EL Gomhoria Street, Mansoura 35516, Egypt. hzahraa211@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Sep 25, 2025; 14(3): 107879 Published online Sep 25, 2025. doi: 10.5527/wjn.v14.i3.107879
Modified National Early Warning Score 2, warning system for predicting treatment outcomes in patients with emphysematous pyelonephritis
Mohammad S Al-Haggar, Zahraa A Abdelmoneim
Mohammad S Al-Haggar, Zahraa A Abdelmoneim, Department of Pediatrics, Genetics and Metabolic Unit, Mansoura University Children’s Hospital, Mansoura 35516, Egypt
Author contributions: Al-Haggar MS revised the manuscript; Abdelmoneim ZA wrote the manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
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: Zahraa A Abdelmoneim, MD, Lecturer, Department of Pediatrics, Genetics and Metabolic Unit, Mansoura University Children’s Hospital, EL Gomhoria Street, Mansoura 35516, Egypt. hzahraa211@gmail.com
Received: April 2, 2025 Revised: May 20, 2025 Accepted: September 2, 2025 Published online: September 25, 2025 Processing time: 168 Days and 23.1 Hours
Abstract
Emphysematous pyelonephritis (EPN) is a severe, a lethal necrotizing upper urinary tract infection, characterized by gas production within the renal parenchyma, collecting system, or perinephric tissue. EPN is emerging as a significant concern, necessitating early diagnosis, severity assessment, and timely intervention to improve outcomes. This study proposes a modified National Early Warning Score 2 (mNEWS 2) to enhance risk stratification and predictive accuracy in EPN management. The mNEWS 2 refines the original NEWS 2 system, which aggregates 6 physiological indicators (body temperature, systolic blood pressure, pulse rate, oxygen saturation, breathing rate, and degree of consciousness), by incorporating weighted risk stratification indices and specific cutoff values derived from clinical observations, statistical modeling, and predictive performance analysis. A pilot study identified optimal thresholds, with a score of 15 maximizing predictive performance for mortality risk and intervention needs, validated through receiver operating characteristic curve analysis. So, the mNEWS 2 score represents a significant advancement in EPN management, offering improved risk stratification and treatment outcomes.
Core Tip: Emphysematous pyelonephritis (EPN) is a life-threatening necrotizing infection of the upper urinary tract, predominantly affecting individuals with diabetes mellitus. Early diagnosis and severity assessment are critical due to its high mortality rate. This study proposes a modified National Early Warning Score 2 (mNEWS 2) to enhance risk stratification and predictive accuracy in EPN management. By refining physiological parameter thresholds and incorporating weighted risk indices, mNEWS 2 improves triaging, prioritizes intensive monitoring, and facilitates timely interventions. Validated through receiver operating characteristic curve analysis, the mNEWS 2 score, particularly at a cutoff of 15, maximizes predictive performance for mortality risk and intervention needs.
