Integrating Modified National Early Warning Score 2, computed tomography staging, and laboratory markers for enhanced prognostic stratification in emphysematous pyelonephritis

Abstract

Emphysematous pyelonephritis (EPN) is a rare but life-threatening urological emergency with no universally accepted management protocol. The Modified National Early Warning Score 2 (mNEWS2), derived exclusively from six physiological parameters, has recently been proposed as a reliable tool for predicting treatment outcomes in EPN. Although higher mNEWS2 scores are associated with increased morbidity and mortality, clinical deterioration typically manifests only after substantial disease progression. In contrast, computed tomography-based classification systems and laboratory parameters - such as anemia, leukocytosis, thrombocytopenia, and hyperglycemia - may offer earlier prognostic insights before physiological deterioration occurs. Evidence from recent multicenter studies has identified these factors as independent predictors of mortality. Therefore, integrating mNEWS2 with computed tomography-based staging and relevant laboratory markers may allow more accurate risk stratification and facilitate timely decision-making, including consideration of early nephrectomy in high-risk patients with extensive paranephric involvement, ultimately improving clinical outcomes in EPN management.

Keywords: Emphysematous pyelonephritis; Modified National Early Warning Score 2; Computed tomography classification; Prognostic factors; Nephrectomy

Core Tip: Emphysematous pyelonephritis is a rapidly progressive and life-threatening infection that necessitates timely and precise prognostic evaluation. Although the Modified National Early Warning Score 2 provides valuable risk information based exclusively on physiological parameters, clinical deterioration typically manifests at a relatively advanced stage. In contrast, computed tomography based staging and critical laboratory indicators, including anemia, thrombocytopenia, leukocytosis, and hyperglycemia, may yield earlier prognostic insights before overt vital-sign abnormalities develop. A combined assessment incorporating Modified National Early Warning Score 2, computed tomography classification, and laboratory indicators may therefore improve early risk stratification, inform timely nephrectomy decisions in high-risk patients, and ultimately optimize clinical outcomes.