PREDICTIVE VALUE OF NEUTROPHIL-TO-LYMPHOCYTE RATIO FOR UNFAVORABLE OUTCOMES IN EMPHYSEMATOUS PYELONEPHRITIS: A CLINICAL RISK STRATIFICATION STUDY

Background: Emphysematous Pyelonephritis (EPN) is life-threatening necrotizing infection of renal parenchyma, which is characterized by the gaseous formation in renal structures. It has close relations with diabetes mellitus. Although historically is the standard of care, nephrectomy is not always the only choice of management as recent studies indicate that conservative management owing to stenting, percutaneous drainage or medical therapy could work. Objective: To determine the frequency of unfavourable outcomes after primary procedures in patients presenting with EPN and compare the frequency of unfavourable outcomes among patients with NLR <5 and >5. Materials and Methods: This descriptive study was conducted at the Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, from 18-06-2020 to 17-12-2020. A total of 66 patients aged 30–70 years with CT-confirmed EPN were included. Patients were grouped by neutrophil-to-lymphocyte ratio (NLR) at admission. Disease severity was assessed using Huang-Tseng classification. All patients were followed for one-month post-intervention to assess outcomes. Results: Mean age was 50.38±11.09 years, and mean disease duration was 3.15±1.47 months. Females were 74.24% of the cohort, and 72.73% were diabetic. NLR >5 was found in 51.52% of cases. Unfavourable outcomes occurred in 24.24%, significantly more in those with NLR >5. Conclusion: NLR is a useful prognostic marker to predict unfavourable outcomes in EPN managed conservatively.