A meta-analysis of risk factors for mortality in patients with emphysematous pyelonephritis

Abstract number: 1733_833

Falagas M.E., Alexiou V.G., Giannopoulou K.P., Siempos I.I.

Objectives: Emphysematous pyelonephritis (EPN), an infection most commonly seen in patients with diabetes mellitus, is associated with considerable case fatality. We sought to identify the factors associated with mortality in patients with EPN and estimate the magnitude of the associations.

Methods: Pub Med was searched to identify studies reporting on risk factors of mortality in patients with EPN. A meta-analysis of the eligible studies was performed.

Results: Seven study cohorts, representing 175 patients with EPN, were included in the meta-analysis. The overall mortality was 25%, ranging from 11% to 42%. Conservative treatment alone [odds ratio (OR) = 2.85, 95% confidence interval (CI): 1.19–6.81), bilateral EPN (OR = 5.36, 95% CI: 1.41–20.33), type I EPN (OR = 2.53, 95% CI: 1.13–5.65), and thrombocytopenia (OR = 22.68, 95% CI: 4.4–116.32) were associated with increased mortality. Systolic blood pressure <90 mmHg, serum creatinine >2.5 mg/dl, and disturbance of consciousness were also found to be associated with increased mortality, based however on limited data. On the other hand, there was no association between mortality and diabetes mellitus (OR = 0.32, 95% CI: 0.05–1.99) in patients with EPN.

Conclusion: Based on the available evidence, conservative treatment, type I EPN, bilateral EPN and thrombocytopenia are significant risk factors for mortality in patients with EPN. These data may be taken under consideration when managing patient with devastating infection.