Background: Emphysematous pyelonephritis (EPN) is a necrotizing infection of the kidney and the surrounding tissues associated with considerable mortality. We aimed to formulate a score that classifies the risk of mortality in patients with EPN at hospital admission. Materials and methods: Patients diagnosed with EPN between 2013 and 2020 were retrospectively included. Data from 15 centers (70%) were used to develop the scoring system, and data from 7 centers (30%) were used to validate it. Univariable and multivariable logistic regression analyses were performed to identify independent factors related to mortality. Receiver operating characteristic curve analysis was performed to construct the scoring system and calculate the risk of mortality. A standardized regression coefficient was used to quantify the discriminating power of each factor to convert the individual coefficients into points. The area under the curve was used to quantify the scoring system performance. An 8-point scoring system for the mortality risk was created (range, 0–7). Results: In total, 570 patients were included (400 in the test group and 170 in the validation group). Independent predictors of mortality in the multivariable logistic regression were included in the scoring system: quick Sepsis-related Organ Failure Assessment score ≥2 (2 points), anemia, paranephric gas extension, leukocyte count >22,000/μL, thrombocytopenia, and hyperglycemia (1 point each). The mortality rate was <5% for scores ≤3, 83.3% for scores 6, and 100% for scores 7. The area under the curve was 0.90 (95% confidence interval, 0.84–0.95) for test and 0.91 (95% confidence interval, 0.84–0.97) for the validation group. Conclusions: Our score predicts the risk of mortality in patients with EPN at presentation and may help clinicians identify patients at a higher risk of death.

Resumen Objetivo: Investigar la correlación entre la calcificación aórtica abdominal (AAC) y las alteraciones urinarias metabólicas subyacentes en formadores de litiasis (SF). Métodos: Pacientes con perfil metabólico urinario de 24 hrs y tomografía computarizada fueron incluidos. Se utilizó el índice de Kauppila (KS) para el análisis cuantitativo de las AAC; y se recabaron datos clínicos y características del lito. Se empleó la prueba de correlación de Spearman. Resultados: Se incluyeron 54 pacientes, con media de edad de 46.4±11.2, 75.9% fueron mujeres y el 59.3% tuvo AAC. La hipertensión y las AAC estuvieron asociadas (p=0.026), y el KS fue mayor en pacientes hipertensos. La hipocitraturia (98.1%) e hipercalciuria (16.7%) fueron las alteraciones urinarias más frecuentes, pero no se relacionaron con las AAC (p>0.05). El perfil metabólico urinario, pruebas bioquímicas, dureza y carga litiásica y el índice de masa corporal no presentaron correlación con el KS (p>0.05). Limitaciones del estudio: El trabajo cursa con limitaciones tal como la naturaleza retrospectiva, una muestra pequeña y la falta evaluación automatizada de las calcificaciones en la aorta abdominal. Conclusión: El vínculo entre las enfermedades cardiovasculares y la litiasis renal necesita ser aclarado. Nuestros resultados contrastan con los poco reportados en la literatura, ya que no encontramos correlación entre las AAC y las alteraciones metabólicas urinarias SF.