[MAKING OF THE DISEASE SEVERITY PREDICTION INDEX FOR ACUTE PYELONEPHRITIS ASSOCIATED WITH URINARY OBSTRUCTION DUE TO URETERAL CALCULI]

(Purpose) Both administration of antibiotics and drainage of urine are necessary for the treatment of acute pyelonephritis associated with urinary obstruction by the ureteral calculi. Though most patients get better after the treatment, some patients deteriorate accompanying with low blood pressure, and need the intensive care. Such patients sometimes visit small hospital, even at night with a few medical staffs. It is sometimes difficult to predict the patient's outcome. The disease severity prediction index for the patients was investigated. (Object and method) We examined 134 patients, who visited our hospital from 2001 to 2013, retrospectively. Ureteral stenting or nephrostomy was undergone within 24 hours in principle. If the blood pressure became under 90 mmHg, or lowered more than 40 mmHg than usual, the case was defined as serious. Blood data and physical findings were compared between serious and non-serious cases. The factors affecting the seriousness were found. Multiple logistic analysis was done to make a disease severity prediction index. (Result) 42 cases were judged as serious and 92 cases as non-serious. Six factors consisting of heart rate, serum creatinine, platelets, ages, PS and CRP affected the consequence significantly (p<0.05), however, white blood cells did not.Multiple logistic analysis was done, four factors consisting of serum creatinine, platelets, PS and CRP affected the consequence significantly (p<0.05), and the standardizing coefficients of each points were found to be 2, 2, 1, 1, respectively.The disease severity prediction index was proposed. If the index was 4 or more, the sensitivity and specificity were found to be 73.8% and 82.6%, respectively. (Conclusion) This index is useful and reliable for the prediction of the outcome of the disease.