Prediction of Mortality and Prolonged Hospitalization in Adults with Acute Pyelonephritis

 

Parameters associated with mortality:

(1) septic shock

(2) bedridden status

(3) age > 65 years

(4) recent antibiotic therapy (in males)

(5) immunosuppression (in females)

 

Parameter	Finding	Points
septic shock	absent	0
	present	1
bedridden status	no	0
	yes	1
age	<= 65 years of age	0
	> 65 years of age	1
recent antibiotic therapy	no	0
	yes	1
immunosuppression	no	0
	yes	1

 

mortality risk score for males =

= (6 * (points for septic shock)) + (4 * (points for bedridden status)) + (4 * (points for age)) + (3 * (points for recent antibiotic therapy))

 

mortality risk score for females =

= (6 * (points for septic shock)) + (4 * (points for bedridden status)) + (4 * (points for age)) + (3 * (points for immunosuppression))

 

Interpretation:

• minimum score: 0

• maximum score: 17

• The higher the score, the greater the risk of mortality.

Risk Score	Risk of In Hospital Mortality
0 to 3	0%
4 to 6	3.4%
7 to 10	66 to 75%
11 to 17	90 to 100%

from page 1210

 

Risk factors for prolonged hospitalization:

(1) change in initial treatment

(2) diabetes mellitus

(3) long-term urinary catheterization

(4) age > 65 years (in men)

 

where:

• I assume that a change in initial treatment pertains to a change in the antibiotic regimen. Patients were started empirically on a regimen pending culture results.

 

Risk factors for having an infection by antibiotic-resistant bacteria:

(1) recent hospitalization

(2) recent use of antibiotics

(3) immunosuppression

(4) recurrent episodes (>= 3 confirmed episodes in past year) of acute pyelonephritis (in males)

(5) nephrolithiasis (in females)