The National Early Warning Score 2 (NEWS2) and the Quick Sequential Organ Failure Assessment (qSOFA) are well-established bedside tools for predicting mortality and assessing clinical deterioration in patients with sepsis and septic shock. Acute Pyelonephritis (APN), a severe upper urinary tract infection, is associated with a reported mortality rate of 6.1% to 25%. However, there is a paucity of literature comparing the utility of these scoring systems specifically in patients with APN. This study aims to address this knowledge gap by evaluating and comparing the accuracy of NEWS2 and qSOFA in predicting the need for expedited care and mortality in APNs.

A prospective comparative study was conducted on 220 consecutive patients diagnosed with APN between October 2023 and October 2024 at a tertiary care hospital in Southern India. Patients with Emphysematous Pyelonephritis were excluded. The NEWS2 score was applied to Group 1 (n = 110), while the qSOFA score was applied to Group 2 (n = 110). Data collected included demographic details and vital signs at presentation. The requirement for oxygen therapy, inotropic or organ support, and evidence of acidosis, uro-sepsis or septic shock defined the need for expedited care. The primary objective was to compare the sensitivity, specificity, and predictive values of NEWS2 and qSOFA in predicting ICU admission, mortality, and length of hospital stay. Each scoring system was then analysed and evaluated and the predictive performance was calculated using the area under the receiver operating characteristic curve (AUROC).

The NEWS2 score exhibited a better sensitivity in predicting ICU admissions (85%) and mortality (78%) compared to the qSOFA score. However, the qSOFA score proved to be more specific for predicting mortality, with a specificity of 88%. In contrast, the sensitivity of qSOFA for ICU admissions and mortality was 68% and 65%, respectively, while NEWS2 had a specificity of 75% for mortality prediction. The demographic and comorbidity profiles of patients were similar between the two groups, and the findings related to the length of hospital stay were also comparable. Overall, NEWS2 demonstrated stronger predictive power, with AUROCs of 0.86 for ICU admissions and 0.85 for mortality. Meanwhile, qSOFA, although slightly less robust for ICU admissions and mortality, performed equally well as NEWS2 in predicting the length of hospital stay, with both scoring an AUROC of 0.77.

The NEWS2 score is a reliable tool for triaging patients with APNs. Its higher sensitivity and predictive values add significant support to this claim. The qSOFA helps identify patients with a lower risk of disease progression. Its higher mortality prediction rate effectively identifies those needing intensive care monitoring. Combining both scoring systems would add synergistic value and be a clinically very useful tool in improving patient outcomes in patients with APN.