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J Korean Soc Emerg Med > Volume 29(3); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(3): 259-266.
응급의료센터를 내원한 급성 신우신염 환자에서 예후예측 인자로서 컴퓨터단층촬영 소견의 유용성
이병근1, 김종원1, 이경룡1, 홍대영1, 백광제1, 박상오1, 김신영1, 김진용2
1건국대학교 의학전문대학원 응급의학교실
2건국대학교 충주병원 응급의학과
The clinical usefulness of computed tomography findings as a prognostic factor for patients with acute pyelonephritis in emergency department
Byeong Geun Lee1, Jong Won Kim1, Kyeong Ryong Lee1, Dae Young Hong1, Kwang Je Baek1, Sang O Park1, Sin Young Kim1, Jin Yong Kim2
1Department of Emergency Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
2Department of Emergency Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
Correspondence  Jin Yong Kim ,Tel: 043-840-8331, Fax: 043-840-8962, Email: palenova@naver.com,
Received: April 18, 2018; Revised: May 18, 2018   Accepted: June 3, 2018.  Published online: June 30, 2018.
This study examined the efficacy of the computed tomography (CT) findings in the emergency department (ED) in predicting the clinical course and severity of acute pyelonephritis (APN).
This retrospective clinical study included APN patients in the ED. All participants diagnosed with APN had undergone a radiocontrast-enhanced CT evaluation. The radiocontrast-enhanced CT findings of APN revealed the typical findings, such as hypoperfusion on the kidney, extra-renal parenchymal findings, and renal abscess formation. The patients were classified into five groups based on the CT findings. The clinical parameters analyzed were the white blood cell (WBC) count, C-reactive protein (CRP) level, quick sepsis-related organ failure-assessment (qSOFA) score, need for vasopressor, length of stay, and admission to the intensive care unit (ICU). The relationships between the clinical parameters and the five groups based on the APN CT findings were assessed.
Among the 264 patients, there were 225 female patients and the mean age of all patients was 57.9±20.5 years: group 1 (n=31), present renal abscess with APN; group 2 (n=118), both typical and extra-renal parenchymal findings; group 3 (n=49), only typical finding; group 4 (n=32), only extra-renal parenchymal findings; and group 5 (n=34), no APN finding on CT. The length of stay increased from groups 5 to 1. The WBC count and CRP level were worsen from groups 4 to 1, except for group 5. Statistically significant trends, such as the WBC count, CRP level and length of stay correlated with each group were observed (P<0.001, P<0.001, and P<0.001). Statistically significant trends in ICU admission, use of vasopressor, and qSOFA score were also observed (P=0.022, P=0.003, and P<0.001).
The specific CT findings of APN might be helpful for predicting the clinical severity and prognosis.
Key words: Pyelonephritis; Spiral computed tomography; Prognosis
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