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A Novel Scoring System to Predict the Risk for Disseminated Intravascular Coagulation in Obstructive Pyelonephritis Complicated with Upper Urinary Tract Calculi

Hiroaki Iwamoto, Kazuyoshi Shigehara, Shohei Kawaguchi, Kouji Izumi, Yoshifumi Kadono, Tohru Miyagi, Takao Nakashima and Atsushi Mizokami

Background: The present study tried to establish a scoring system to predict the development of disseminated intravascular coagulation (DIC) in obstructive pyelonephritis complicated with upper urinary tract calculi.

Methods: We retrospectively reviewed 103 patients who were hospitalized in our institution between 2007 and 2013. All patients were divided into two groups: patients with DIC (severe group) and those without DIC (non-severe group). Background characteristics were analyzed to determine predictive factors.

Results: Patients were 27–91 years (mean, 64.8 years) and included 22 men and 81 women. DIC was observed in 14 (13.6%) cases. Comparison of background data between both groups demonstrated that older age, poor performance status (PS), septic shock, and no history of urinary stones were risk factors for the development of DIC. Hence, these four clinical factors became the H.A.P.S. scoring system (range, 0–4) predictive for the development of DIC. One point was scored for each factor: no history (H), age ≥ 70 years (A), PS ≥ 3 (P), and septic shock (S). Patients with a H.A.P.S. score ≥ 3 were statistically more likely to develop DIC than those with scores of 0–2. The sensitivity and specificity of the H.A.P.S. score were 92.9% [95% confidence interval (CI): 72.0% –98.7%] and 89.9% (95% CI: 86.6–90.8%), respectively, and its diagnostic odds ratio was 115.6 (95% CI: 16.6–753.8).

Conclusion: The H.A.P.S. scoring system is a useful tool for predicting the development of DIC in patients with obstructive pyelonephritis complicated with urinary calculi.