Abstract
Background/Objectives: To assess associations between quantitative computed tomography (CT) features, inflammatory markers, and length of hospital stay (LOS) in acute pyelonephritis (APN). Methods: This retrospective single-center study included 82 patients with CT-confirmed APN. Two radiologists quantified renal perfusion-deficit volume and percentage and perirenal fat-stranding (PFS) area and attenuation. Associations with C-reactive protein (CRP), white blood cell (WBC) count, procalcitonin, and LOS were assessed using Spearman correlation and regression analyses. Receiver operating characteristic (ROC) curve analysis evaluated LOS ≥ 10 days. Results: Perfusion-deficit volume and percentage correlated strongly with CRP (ρ = 0.763 and 0.714; both p < 0.001) and weakly with WBC count (ρ = 0.379 and 0.374; both p < 0.001). PFS area correlated moderately with procalcitonin (ρ = 0.482, p = 0.001; n = 42). Both perfusion-deficit measures correlated moderately with LOS (ρ = 0.538 and 0.536; both p < 0.001). In adjusted linear regression, CRP remained associated with LOS (Coefficient = 0.523 days per 10 mg/L; 95% CI, 0.345–0.692; p < 0.001), whereas perfusion-deficit percentage did not (p = 0.430). In adjusted logistic regression, CRP, age, and male sex were associated with LOS ≥ 10 days. The multivariable model yielded an AUC of 0.883 (95% CI, 0.81–0.95). Results were unchanged in a sensitivity analysis excluding the seven outpatients, and bootstrap internal validation yielded an optimism-corrected AUC of 0.86. Conclusions: Quantitative renal perfusion deficits were associated with inflammatory burden and LOS in univariable analyses. CRP showed the most consistent independent association, whereas the incremental value of CT metrics requires external validation.