Modified National Early Warning Score 2, warning system for predicting treatment outcomes in patients with emphysematous pyelonephritis.

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.