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Prevalence and Risk Factors of Mortality in Emphysematous Pyelonephritis Patients: A Meta-Analysis

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Abstract

Background

Emphysematous pyelonephritis (EP) is a severe necrotizing infection of the renal parenchyma which is associated with significant case mortality. We sought to identify the incidence and predictive risk factors associated with EP mortality.

Methods

Two electronic databases, PubMed and Web of Science, were searched from their inception until June 06, 2021 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines.

Results

Of the 1080 retrieved abstracts, 79 underwent full-text review and 45 studies were included in the final analysis, comprising a total cohort of 1303 patients and 177 mortalities. The pooled prevalence of mortality among the patients with EP disease was 13%. Our analysis found a significantly decreasing trend in mortality rates, an increasing trend in minimally invasive intervention and decreasing trends in emergency nephrectomy in the EP studies from 1985 to 2020. Significant risk factors that were associated with a negative impact on survival of EP patients included sepsis (OR = 15.99), shock (OR = 15.57), disturbance of consciousness (OR = 12.11), thrombocytopenia (OR 7.85), acute renal failure (OR = 5.41), Wan classification I (OR = 4.57), emergency nephrectomy (OR = 3.73), Huang–Tseng classification III–IV (OR = 2.4) and medical management alone (OR = 2.04). Female sex (OR = 0.52) and minimally invasive intervention (OR = 0.47) (percutaneous nephrostomy or ureteral stent placement) were associated with decreased mortality rates.

Conclusions

Our study results demonstrated several significant risk factors that could help guide treatment to reduce the mortality risk of EP patients. Clinically, early treatment with a combination of minimally invasive intervention and appropriate medical management may be protective for reducing mortality risk in EP patients.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

CT:

Computer tomography

DM:

Diabetes mellitus

EN:

Emergency nephrectomy

EP:

Emphysematous pyelonephritis

NOS:

Newcastle–Ottawa scale

PCD:

Percutaneous drainage

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

SD:

Standard deviation

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Acknowledgements

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This study receives no funding support.

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Author notes

  1. Xuan Thai Ngo and Tuan Thanh Nguyen contributed equally to this work.

Authors and Affiliations

  1. University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam

    Xuan Thai Ngo, Tuan Thanh Nguyen, Minh Sam Thai, Khoa Quy, Hieu Trong Le, Tien-Dat Hoang, Hanh Thi Tuyet Ngo & Trinh Ngoc Khanh Van

  2. Department of Urology, Cho Ray Hospital, Ho Chi Minh City, Vietnam

    Xuan Thai Ngo, Tuan Thanh Nguyen, Minh Sam Thai, Duc Huy Vu & Le Quy Van Dinh

  3. Cook County Health and Hospitals System, Chicago, USA

    Ryan W. Dobbs

  4. National University Hospital, Singapore, Singapore

    Ho Yee Tiong

  5. Oklahoma University Health Sciences Center, Oklahoma, USA

    Huy Gia Vuong

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Contributions

XTN and TTN contributed to project development, data collection, data analysis, and manuscript writing. RWD and MST contributed to data analysis and manuscript writing and editing. DHV, VDLQ, KQ, THL, TDH, HTTN and TNKV contributed to data collection and data analysis. HYT contributed to protocol development and manuscript writing and editing. HGV contributed to project development, data analysis, and manuscript writing.

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Correspondence to Huy Gia Vuong.

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Ngo, X.T., Nguyen, T.T., Dobbs, R.W. et al. Prevalence and Risk Factors of Mortality in Emphysematous Pyelonephritis Patients: A Meta-Analysis. World J Surg 46, 2377–2388 (2022). https://doi.org/10.1007/s00268-022-06647-1

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