응급의료센터를 내원한 급성 신우신염 환자에서 예후예측 인자로서컴퓨터단층촬영 소견의 유용성 (The clinical usefulness of computed tomography findings as a prognostic factor for patients with acute pyelonephritis in emergency department)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 29권 / 3호 / 259 ~ 266페이지
· 저자명 : 이병근, 김종원, 이경룡, 홍대영, 백광제, 박상오, 김신영, 김진용

초록

Objective: This study examined the efficacy of the computed tomography (CT) findings in the emergency department (ED) in predicting the clinical course and severity of acute pyelonephritis (APN).
Methods: This retrospective clinical study included APN patients in the ED. All participants diagnosed with APN had undergone a radiocontrast-enhanced CT evaluation. The radiocontrast-enhanced CT findings of APN revealed the typical findings, such as hypoperfusion on the kidney, extra-renal parenchymal findings, and renal abscess formation. The patients were classified into five groups based on the CT findings. The clinical parameters analyzed were the white blood cell (WBC) count, C-reactive protein (CRP) level, quick sepsis-related organ failure-assessment (qSOFA) score, need for vasopressor, length of stay, and admission to the intensive care unit (ICU). The relationships between the clinical parameters and the five groups based on the APN CT findings were assessed.
Results: Among the 264 patients, there were 225 female patients and the mean age of all patients was 57.9±20.5 years: group 1 (n=31), present renal abscess with APN; group 2 (n=118), both typical and extra-renal parenchymal findings; group 3 (n=49), only typical finding; group 4 (n=32), only extra-renal parenchymal findings; and group 5 (n=34), no APN finding on CT. The length of stay increased from groups 5 to 1. The WBC count and CRP level were worsen from groups 4 to 1, except for group 5. Statistically significant trends, such as the WBC count, CRP level and length of stay correlated with each group were observed (P<0.001, P<0.001, and P<0.001). Statistically significant trends in ICU admission, use of vasopressor, and qSOFA score were also observed (P=0.022, P=0.003, and P<0.001).
Conclusion: The specific CT findings of APN might be helpful for predicting the clinical severity and prognosis.

영어초록

Objective: This study examined the efficacy of the computed tomography (CT) findings in the emergency department (ED) in predicting the clinical course and severity of acute pyelonephritis (APN).
Methods: This retrospective clinical study included APN patients in the ED. All participants diagnosed with APN had undergone a radiocontrast-enhanced CT evaluation. The radiocontrast-enhanced CT findings of APN revealed the typical findings, such as hypoperfusion on the kidney, extra-renal parenchymal findings, and renal abscess formation. The patients were classified into five groups based on the CT findings. The clinical parameters analyzed were the white blood cell (WBC) count, C-reactive protein (CRP) level, quick sepsis-related organ failure-assessment (qSOFA) score, need for vasopressor, length of stay, and admission to the intensive care unit (ICU). The relationships between the clinical parameters and the five groups based on the APN CT findings were assessed.
Results: Among the 264 patients, there were 225 female patients and the mean age of all patients was 57.9±20.5 years: group 1 (n=31), present renal abscess with APN; group 2 (n=118), both typical and extra-renal parenchymal findings; group 3 (n=49), only typical finding; group 4 (n=32), only extra-renal parenchymal findings; and group 5 (n=34), no APN finding on CT. The length of stay increased from groups 5 to 1. The WBC count and CRP level were worsen from groups 4 to 1, except for group 5. Statistically significant trends, such as the WBC count, CRP level and length of stay correlated with each group were observed (P<0.001, P<0.001, and P<0.001). Statistically significant trends in ICU admission, use of vasopressor, and qSOFA score were also observed (P=0.022, P=0.003, and P<0.001).
Conclusion: The specific CT findings of APN might be helpful for predicting the clinical severity and prognosis.

참고자료

· 없음