Integrating Modified National Early Warning Score 2, computed tomography staging, and laboratory markers for enhanced prognostic stratification in emphysematous pyelonephritis

Emphysematous pyelonephritis (EPN) is a rare but life-threatening urological emergency with no universally accepted management protocol. The Modified National Early Warning Score 2 (mNEWS2), derived exclusively from six physiological parameters, has recently been proposed as a reliable tool for predicting treatment outcomes in EPN. Although higher mNEWS2 scores are associated with increased morbidity and mortality, clinical deterioration typically manifests only after substantial disease progression. In contrast, computed tomography-based classification systems and laboratory parameters - such as anemia, leukocytosis, thrombocytopenia, and hyperglycemia - may offer earlier prognostic insights before physiological deterioration occurs. Evidence from recent multicenter studies has identified these factors as independent predictors of mortality. Therefore, integrating mNEWS2 with computed tomography-based staging and relevant laboratory markers may allow more accurate risk stratification and facilitate timely decision-making, including consideration of early nephrectomy in high-risk patients with extensive paranephric involvement, ultimately improving clinical outcomes in EPN management.