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©The Author(s) 2025.
World J Nephrol. Jun 25, 2025; 14(2): 103035
Published online Jun 25, 2025. doi: 10.5527/wjn.v14.i2.103035
Published online Jun 25, 2025. doi: 10.5527/wjn.v14.i2.103035
Table 1 Grouping of patients based on original National Early Warning Score 2 and its various modifications, n (%)
| Original NEWS 2 score | |||||||
| Weighted average risk stratification index | Group 1: Score 0-4 (n = 48) | Group 2: Score 5 and 6 (n = 35) | Group 3: Scores 7-20 (n = 88) | P value | |||
| 1.875 | 1.857 | 2.44 | 0.02 | ||||
| Risk stratification index (rounded off) | 2 | 2 | 2 | ||||
| Need for intervention | 33 (68.75) | 27 (77.14) | 71 (80.68) | < 0.01 | |||
| Mortality | 0 | 0 | 8 | < 0.01 | |||
| Group 3, subdivided into two | |||||||
| Weighted average risk stratification index | Group 1: Score 0-4 (n = 48) | Group 2: Score 5 and 6 (n = 35) | Group 3: Scores 7-20 (n = 88) | P value | |||
| Scores 7-14 (n = 76) | Scores 15-20 (n = 12) | ||||||
| 1.875 | 1.857 | 2.319 | 3.75 | < 0.01 | |||
| Risk stratification index (rounded off) | 2 | 2 | 2 | 3 | |||
| Need for intervention | 40 (83.33) | 27 (77.14) | 61 (80.26) | 12 (100) | < 0.01 | ||
| Mortality | 0 | 0 | 1 | 7 | < 0.01 | ||
| Group 3, subdivided into three | |||||||
| Risk stratification | Group 1: Score 0-4 (n = 48) | Group 2: Score 5 and 6 (n = 35) | Group 3: Scores 7-10 (n = 55) | Group 4: Scores 11-14 (n = 21) | Group 5: Scores 15-20 (n = 12) | P value | |
| Weighted average risk stratification index | 1.875 | 1.857 | 1.982 | 2.762 | 3.75 | < 0.01 | |
| Weighted average risk stratification index (rounded off) | 2 | 2 | 2 | 3 | 4 | ||
| Need for intervention | 40 (83.33) | 27 (77.14) | 44 (80) | 17 (80.95) | 12 (100) | < 0.01 | |
| mortality | 0 | 0 | 0 | 1 | 7 | < 0.01 | |
| Modified NEWS 2 scoring system | |||||||
| Parameters | Group 1: Score 0-6 (n = 83) | Group 2: Score 7-14: n = 76 | Group 3: Score 15-20 (n = 12) | P value | |||
| Weighted average Risk stratification index | 1.867 | 2.039 | 3.75 | < 0.01 | |||
| Risk stratification index (rounded off) | 2 | 2 | 4 | ||||
| Need for intervention | 67 (80.72) | 60 (78.95) | 12 (100) | < 0.01 | |||
| mortality | 0 | 1 (1.32) | 7 (58.33) | < 0.01 | |||
Table 2 Cutoff National Early Warning Score 2 for mortality
| Cutoff National Early Warning Score 2 for mortality | Sensitivity % (95%CI) | Specificity % (95%CI) | Positive predictive value % (95%CI) | Negative predictive value % (95%CI) | Accuracy % (95%CI) |
| ≥ 7 | 100 (63.06-100) | 50.92 (42.98-58.82) | 9.09 (7.88-10.47) | 100 (95.65-100) | 53.22 (45.45-60.87) |
| ≥ 8 | 100 (63.06-100) | 58.90 (50.93-66.53) | 10.67 (9.04-12.55) | 100 (96.23-100) | 60.82 (53.07-68.18) |
| ≥ 9 | 100 (63.06-100) | 69.94 (62.27-76.86) | 14 (11.44-17.10) | 100 (96.82-100) | 71.35 (63.94-77.99) |
| ≥ 10 | 100 (63.06-100) | 80.98 (74.10-86.7) | 20.51 (15.82-26.16) | 100 (97.24-100) | 81.87 (75.27-87.34) |
| ≥ 11 | 100 (63.06-100) | 84.66 (78.20-89.82) | 25.24 (18.24-31.46) | 100 (97.36-100) | 85.38 (79.18-90.31) |
| ≥ 12 | 100 (63.06-100) | 86.50 (80.28-91.34) | 26.67 (19.78-34.91) | 100 (97.42-100) | 87.13 (81.17-91.76) |
| ≥ 13 | 100 (63.06-100) | 89.57 (83.83-93.81) | 32 (23.08-42.46) | 100 (97.51-100) | 90.06 (84.56-94.10) |
| ≥ 14 | 100 (63.06-100) | 91.41 (86.01-95.22) | 36.36 (25.72-48.53) | 100 (97.55-100) | 91.81 (86.64-95.45) |
| ≥ 15 | 87.50 (47.35-99.68) | 96.93 (92.99-99) | 58.33 (36.23-77.53) | 99.37 (96.19-99.9) | 96.49 (92.52-98.70) |
| ≥ 16 | 75 (34.91-96.81) | 98.16 (94.72-99.62) | 66.67 (37.82-86.8) | 98.77 (96.01-99.63) | 97.08 (93.31-99.04) |
| ≥ 17 | 50 (15.7-84.3) | 98.77 (95.64-99.85) | 66.67 (29.97-90.34) | 97.58 (95.27-98.77) | 96.49 (92.52-98.7) |
| ≥ 18 | 25 (3.19-65.09) | 100 (97.76-100) | 100 (15.81-100) | 96.45 (94.79-97.59) | 96.49 (92.52-98.7) |
| ≥ 19 | 12.50 (0.32-52.65) | 100 (97.76-100) | 100 (2.50-100) | 95.88 (94.71-96.8) | 95.91 (91.75-98.34) |
Table 3 Demographic data of emphysematous pyelonephritis patients in our study, n (%)
| Pt characteristics | Group 1: Score 0-6 (n = 83) | Group 2: Score 7-14 (n = 76) | Group 3: Score 15-20 (n = 12) | P value |
| Mean age in years (SD) | 52.639 (10.55) | 55.553 (11.95) | 60.083 (3.45) | 0.046 |
| Age > 50 years | 0.053 | |||
| Yes | 56 (67.47) | 57 (75) | 12 (100) | |
| No | 27 (32.53) | 19 (25) | 0 | |
| Sex | ||||
| Male | 39 (46.99) | 25 (32.90) | 5 (41.67) | 0.194 |
| Female | 44 (53.01) | 51 (67.10) | 7 (58.33) | |
| Sex (female:male) | 1.1:1 | 2.1:1 | 1.4:1 | |
| Laterality | 0.162 | |||
| Unilateral | 68 (81.93) | 70 (92.10) | 10 (83.33) | |
| Bilateral | 15 (18.07) | 6 (7.90) | 2 (16.67) | |
| Body temp | < 0.01 | |||
| No fever | 29 (34.94) | 11 (14.47) | 0 (0) | |
| Temp between 37-40 °C | 54 (65.06) | 58 (76.31) | 5 (41.67) | |
| Temp < 36.8 °C, > 40 °C | 0 | 7 (9.21) | 7 (58.33) | |
| Level of consciousness | < 0.01 | |||
| Alert | 82 (98.8) | 51 (67.10) | 4 (33.33) | |
| Disoriented/unconscious | 1 (1.2) | 25 (32.90) | 8 (66.67) | |
| Other parameters | ||||
| Palpable tender kidney | 7 (8.43) | 48 (63.16) | 12 (100) | < 0.01 |
| Shock at presentation | 1 (1.21) | 20 (2.63) | 11 (91.67) | < 0.01 |
| Need for intensive care unit care | 9 (10.84) | 43 (56.58) | 12 (100) | < 0.01 |
| Need for hemodialysis | 5 (5.95) | 15 (19.74) | 11 (91.67) | < 0.01 |
| Presence of diabetes mellitus | 71 (85.6) | 73 (96.1) | 12 (100) | 0.035 |
| Early nephrectomy | 0 (0) | 2 (2.63) | 6 (50) | < 0.01 |
| Mean combined prognostic scoring (SD) | 10.74 (3.81) | 12.95 (3.90) | 21.92 (2.61) | < 0.01 |
| Risk stratification index | < 0.01 | |||
| 1 | 22 (26.5) | 9 (11.84) | 0 | |
| 2 | 50 (60.24) | 46 (60.52) | 0 | |
| 3 | 11 (13.25) | 18 (23.68) | 3 (25) | |
| 4 | 0 (0) | 3 (3.95) | 9 (75) | |
Table 4 Biochemical and radiological variables, n (%)
| Biochemical variables | Group 1: Score 0-6 (n = 83) | Group 2: Score 7-14 (n = 76) | Group 3: Score 15-20 (n = 12) | P value |
| Absolute leukocyte count (SD) | 15394.2 (6895.11) | 16489.3 (7478.58) | 20778.3 (7875.63) | 0.152 |
| Heart rate (per minute) (SD) | 86.711 (12.58) | 90.026 (17.79) | 110.750 (21.16) | < 0.01 |
| Blood sugar on admission (mg/dL) (SD) | 245.578 (100.78) | 323.21 (129.33) | 346.167 (59.12) | < 0.01 |
| Hemoglobin A1c (SD) | 8.712 (2.55) | 9.375 (1.7) | 10.07 (2.59) | 0.023 |
| S creatinine on admission (mg/dL) (SD) | 3.187 (2.21) | 3.928 (2.54) | 5.14 (1.45) | 0.003 |
| International normalized ratio test (SD) | 1.18 (0.18) | 1.27 (0.31) | 1.86 (0.61) | < 0.01 |
| Serum sodium level (mEq/L) (SD) | 131.94 (6.03) | 131.90 (5.76) | 123.58 (4.89) | < 0.01 |
| Serum albumin (grams/dL) (SD) | 3.14 (0.65) | 3.08 (0.73) | 2.392 (0.45) | 0.004 |
| Platelet count (SD) | 220695.181 (128292.52) | 124053.947 (87178.32) | 54575.000 (25853.30) | < 0.01 |
| Mean hospital stay (days) (SD) | 5.7 (2.99) | 7.6 (3.72) | 8.3 (4.72) | < 0.01 |
| Computed tomography classification | < 0.01 | |||
| Class 1 | 32 (38.55) | 11 (14.47) | 0 (0) | |
| Class 2 | 25 (30.12) | 33 (43.42) | 0 (0) | |
| Class 3A | 9 (10.84) | 9 (11.82) | 1 (8.33) | |
| Class 3B | 2 (2.41) | 15 (19.74) | 2 (2.63) | |
| Class 4 | 15 (18.07) | 8 (10.53) | 9 (11.84) |
Table 5 Summary of treatment given to our patients, n (%)
| Treatment given | Group 1: Score 0-6 (n = 83) | Group 2: Score 7-14 (n = 76) | Group 3: Score 15-20 (n = 12) | P value |
| Non-surgical treatment (n = 32) | 32 (100) | 0 (0) | 0 (0) | < 0.01 |
| DJ stenting (n = 127) | 49 (59) | 72 (94.7) | 6 (50) | < 0.01 |
| Percutaneous nephrostomy (n = 26) | 4 (4.8) | 14 (18.4) | 8 (66.7) | < 0.01 |
| Percutaneous catheter drainage (n = 28) | 5 (6) | 16 (21.1) | 7 (58.3) | < 0.01 |
| Need for hemodialysis (n = 31) | 5 (6) | 15 (19.7) | 11 (91.7) | < 0.01 |
| Early nephrectomy (n = 8) | 0 (0) | 2 (2.6) | 6 (50) | < 0.01 |
| Mortality (n = 8) | 0 (0) | 1 (1.3) | 7 (58.3) | < 0.01 |
Table 6 Summary of key clinical differences among emphysematous pyelonephritis groups
| Clinical parameter | Group 1 (NEWS 2: 0-6, n = 83) | Group 2 (NEWS 2: 7-14, n = 76) | Group 3 (NEWS 2: 15-20, n = 12) | P value |
| Percentage (95%CI)/mean ± SD (95%CI) | ||||
| Age > 50 years (%) | 67.50 (58.9-75.4) | 75 (65.4-82.8) | 100 (73.5-100) | 0.046 |
| Body temperature extremes (%) | 0 (0-4.4) | 9.21 (4.5-17.8) | 58.30 (34.8-78.4) | < 0.01 |
| Shock at presentation (%) | 1.20 (0.2-6.5) | 26.30 (18.2-36.1) | 91.70 (65.3-98.8) | < 0.01 |
| Altered consciousness (%) | 1.20 (0.2-6.5) | 32.90 (24.2-42.9) | 66.70 (41.0-85.6) | < 0.01 |
| Palpable tender kidney (%) | 8.40 (4.1-16.3) | 63.20 (52.4-72.9) | 100 (73.5-100) | < 0.01 |
| Presence of diabetes mellitus (%) | 85.6 (76.1-92) | 96.1 (88.9-99.18) | 100 (73.5-100) | 0.035 |
| Need for intensive care unit care (%) | 10.80 (6.0-18.6) | 56.60% (45.7-66.9) | 100 (73.5-100) | < 0.01 |
| Need for hemodialysis (%) | 6.00 (2.7-12.7) | 19.70% (12.7-29.2) | 91.70 (65.3-98.8) | < 0.01 |
| Early nephrectomy (%) | 0 (0-4.4) | 2.60 (0.7-9.0) | 50 (26.9-73.1) | < 0.01 |
| Mortality (%) | 0 (0-4.4) | 1.30 (0.2-6.9) | 58.30 (34.8-78.4) | < 0.01 |
| Heart rate (per minute) | 86.71 ± 12.58 (84.004- 89.416) | 90.03 ± 17.79 (86.03-94.03) | 110.75 ± 21.16 (98.78-122.72) | < 0.01 |
| Mean blood sugar (mg/dL) | 245.6 ± 100.8 (225.4-265.8) | 323.2 ± 129.3 (298.5-347.9) | 346.2 ± 59.1 (325.4-367.0) | < 0.01 |
| Serum creatinine (mg/dL) | 3.18 ± 2.21 (2.7-3.6) | 3.92 ± 2.54 (3.3-4.5) | 5.14 ± 1.45 (4.6-5.7) | 0.003 |
| Serum albumin (g/dL) | 3.14 ± 0.65 (2.9-3.3) | 3.08 ± 0.73 (2.9-3.3) | 2.39 ± 0.45 (2.2-2.6) | 0.004 |
| Hemoglobin A1c | 8.712 ± 2.55 (8.16- 9.26) | 9.375 ± 1.7 (8.99-9.76) | 10.07 ± 2.59 (8.665-11.53) | 0.023 |
| Sodium (mEq/L) | 131.94 ± 6.03 (130.3-133.6) | 131.90 ± 5.76 (130.3-133.4) | 123.58 ± 4.89 (121.4-125.8) | < 0.01 |
| International normalized ratio test | 1.18 ± 0.18 (1.14- 1.22) | 1.27 ± 0.31 (1.2- 1.34) | 1.86 ± 0.61 (1.515-2.205) | < 0.01 |
| Platelet count | 220695 ± 128292 (189345-252045) | 124053 ± 87178 (101345-146761) | 54575 ± 25853 (45676-63474) | < 0.01 |
| Computed tomography class 3/4 (%) | 20.50 (13.6-29.6) | 30.30 (21.5-40.4) | 100% (73.5-100) | < 0.01 |
| Risk stratification index (mean ± SD) | 1.867 ± 0.35 (1.8-2.0) | 2.039 ± 0.45 (1.9-2.2) | 3.75 ± 0.50 (3.5-4.0) | < 0.01 |
| Combined prognostic scoring index (mean ± SD) | 10.74 ± 3.81 (9.8-11.7) | 12.95 ± 3.90 (11.9-14.0) | 21.92 ± 2.61 (20.9-23.0) | < 0.01 |
- Citation: Krishnamoorthy S, Thiruvengadam G, Sekar H, Palaniyandi V, Ramadurai S, Narayanasamy S. Modified National Early Warning Score 2, a reliable early warning system for predicting treatment outcomes in patients with emphysematous pyelonephritis. World J Nephrol 2025; 14(2): 103035
- URL: https://www.wjgnet.com/2220-6124/full/v14/i2/103035.htm
- DOI: https://dx.doi.org/10.5527/wjn.v14.i2.103035