Objectives <p>The purpose of this study was to investigate the predictors of in-hospital mortality of patients with emphysematous pyelonephritis (EP) by type of management. </p> Methods <p>Retrospective data were collected on 176 patients with EP who had undergone treatment at our hospital between 2011 and 2019. Data collected included demographic characteristics, clinical presentations, management strategies, and survival rates. The independent variables with a p value &lt; 0.05 in the univariate analysis were selected for multivariate logistic regression analysis to identify the independent factors significantly associated with mortality. </p> Results <p>The mean age was 59.1 ± 12.7 years. Among the cases, 143 were women (81.2%) and 127 had diabetes mellitus (72.2%). Urinary obstruction occurred in 61.9% of patients. The left kidney was affected in 80 patients (45.4%) and bilateral involvement was present in 7 patients (4%). There were 12 deaths (6.8%) within our cohort. Risk factors significantly associated with mortality include age (p = 0.002), bilateral involment (p = 0.003), shock (p &lt; 0.001), thrombocytopenia (p = 0.016), and medical management alone (p = 0.003).</p> Conclusions <p>Our study identified the key risk factors associated with the mortality in EP patients, including advanced age, bilateral kidney involvement, shock, thrombocytopenia, and medical treatment alone. These results reinforce the importance of early recognition and risk management to improve EP patients’ outcomes.</p>