Dual-score framework: National Early Warning Score 2 and quick Sequential Organ Failure Assessment scores in acute...

Acute pyelonephritis (APN) is a significant part of the healthcare burden globally. Early risk stratification in APN is crucial to guide intensive care unit (ICU) admission and anticipate in-hospital mortality. The relevance of scoring tools like quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score 2 (NEWS2) in urology-specific infections has been unclear. Our study is among the first to prospectively compare the qSOFA and NEWS2 scores exclusively in non-emphysematous APN, a real-world cohort previously overlooked in research.

To assess the accuracy of NEWS2 and qSOFA scores in predicting ICU admission, in-hospital mortality and their role in guiding urological interventions among adults with APN.

A prospective observational study, conducted at a tertiary care centre in South India over two years, on adult patients diagnosed clinically and radiologically with APN. Comprehensive clinical, laboratory, and imaging parameters were recorded. The cohort was stratified into patients requiring ICU and not requiring ICU to assess differences across parameters. The discriminative power of the NEWS2 and qSOFA scores for predicting expedited care and mortality was analyzed.

The NEWS2 score ≥ 5 emerged as a robust tool, identifying nearly all patients requiring ICU admission [sensitivity, 98.1%; area under the receiver operating characteristic curve (AUC): 0.977; P < 0.05] and predicting intervention with high accuracy (AUC-0.823; P < 0.05). However, the qSOFA ≥ 2 score proved to be the silent sentinel of mortality (AUC-0.839; P < 0.05), outperforming the NEWS2 score in prognostication. Interestingly, patients who later required ICU care had elevated NEWS2 scores at baseline, suggesting the missed early red flags. To the best of our knowledge, this is the first and largest prospective study to compare NEWS2 and qSOFA scores exclusively in non-obstructive, non-emphysematous APN.

In APN, NEWS2 (≥ 5) proved to be a pragmatic trigger for ICU triage, while qSOFA (≥ 2) better flagged in-hospital mortality. Together, they form a complementary framework as a simple, objective, and lifesaving bedside tool.