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No AccessJournal of UrologyAdult urology1 Sep 2007

Risk Factors for Mortality in Patients With Emphysematous Pyelonephritis: A Meta-Analysis

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    Emphysematous pyelonephritis, an infection most commonly seen in cases of diabetes mellitus, is associated with considerable case fatality. We identified the factors associated with mortality in patients with emphysematous pyelonephritis and estimated the magnitude of the associations.

    Materials and Methods:

    PubMed® was searched to identify studies reporting on risk factors of mortality in patients with emphysematous pyelonephritis. A meta-analysis of the eligible studies was performed.


    Seven study cohorts, representing 175 patients with emphysematous pyelonephritis, were included in the meta-analysis. The overall mortality rate was 25%, ranging from 11% to 42%. Conservative treatment alone (OR 2.85, 95% CI 1.19–6.81), bilateral emphysematous pyelonephritis (OR 5.36, 95% CI 1.41–20.33), type I emphysematous pyelonephritis (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 less than 90 mm Hg, serum creatinine greater than 2.5 mg/dl and disturbance of consciousness were also found to be associated with increased mortality. However, this finding was based 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 emphysematous pyelonephritis.


    The accumulated and analyzed evidence suggests that conservative treatment, type I emphysematous pyelonephritis, bilateral emphysematous pyelonephritis and thrombocytopenia seem to be significant risk factors for mortality in patients with emphysematous pyelonephritis. These data may be taken into consideration when treating patients with this devastating infection.


    • 1 : Emphysematous pyelonephritis. J Urol1984; 131: 203. LinkGoogle Scholar
    • 2 : Emphysematous pyelonephritis in diabetic patients. Br J Urol1995; 75: 71. Google Scholar
    • 3 : Emphysematous pyelonephritis. J Urol1962; 87: 762. LinkGoogle Scholar
    • 4 : Mixed acid fermentation of glucose as a mechanism of emphysematous urinary tract infection. J Urol1991; 146: 148. LinkGoogle Scholar
    • 5 : Emphysematous pyelonephritis: diagnosis and treatment. Ann Urol (Paris)2005; 39: 49. Google Scholar
    • 6 : Emphysematous pyelonephritis: report of 3 cases. Ann Urol (Paris)2001; 35: 97. Google Scholar
    • 7 : Emphysematous pyelonephritis: report of 3 cases. Prog Urol2001; 11: 703. Google Scholar
    • 8 : Emphysematous pyelonephritis: diagnosis and treatment. South Med J1986; 79: 41. Google Scholar
    • 9 : Emphysematous pyelonephritis: A report of 2 cases. S Afr Med J1983; 63: 166. Google Scholar
    • 10 : Acute gas-producing bacterial renal infection: Correlation between imaging findings and clinical outcome. Radiology1996; 198: 433. Google Scholar
    • 11 : Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst1959; 22: 719. MedlineGoogle Scholar
    • 12 : Severe emphysematous pyelonephritis in diabetic patients: diagnosis and aspects of surgical management. Urol Int2005; 75: 123. Google Scholar
    • 13 : Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect2001; 34: 125. Google Scholar
    • 14 : Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med2000; 160: 797. Google Scholar
    • 15 : Emphysematous pyelonephritis: imaging diagnosis and follow-up. Kaohsiung J Med Sci1999; 15: 159. Google Scholar
    • 16 : Predictors of outcome in emphysematous pyelonephritis. J Urol1998; 159: 369. LinkGoogle Scholar
    • 17 : Emphysematous pyelonephritis: a 15-year experience with 20 cases. Urology1997; 49: 343. Google Scholar
    • 18 : Emphysematous pyelonephritis: a 5-year experience with 13 patients. J Urol1985; 34: 1086. Google Scholar
    • 19 : Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis2005; 46: 432. Google Scholar
    • 20 : Clinical and radiological findings in patients with gas forming renal abscess treated conservatively. J Urol1999; 162: 1273. LinkGoogle Scholar