Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, No.168, Changhai Rd, Shanghai, 200433, China.
World J Urol. 2020 Jan;38(1):219-229. doi: 10.1007/s00345-019-02748-0. Epub 2019 Apr 9.
To describe the clinical characteristics of struvite stones and determine the preoperative predictors of sepsis in struvite patients undergoing percutaneous nephrolithotomy (PCNL).
A retrospective study of patients who underwent PCNL between April 2011 and March 2018 was performed. The data of the struvite stones and non-struvite stones groups were compared following propensity score matching. Subsequently, the struvite stones group was sub-divided for further analysis according to the Sepsis-3 definition: non-sepsis and sepsis groups.
After matching based on age, gender, BMI, and number of access tracts, the comparative analysis showed that staghorn calculi and higher Guy's stone score were more frequently observed in non-struvite stone patients (n = 97), while a history of urolithiasis surgery (56.70%), preoperative broad-spectrum antibiotic therapy (53.61%), positive preoperative urine culture (55.67%), and sepsis (35.05%) after surgery were more common in patients (n = 97) with struvite stones (all P values < 0.05). Eighteen (18.56%) patients presented with multidrug-resistant (MDR) bacteriuria. Multivariate analysis demonstrated that the preoperative presence of MDR bacteriuria (OR = 3.203; P = 0.043) and increased serum creatinine (OR = 3.963; P = 0.010) were independent risk predictors of sepsis. The two factors were used to construct a nomogram to predict the probability of sepsis. The nomogram was well calibrated and had moderate discriminative ability (concordance index: 0.711).
Our study revealed that patients with struvite stones were associated with a significantly high risk of calculi recurrence and sepsis after surgery. The presence of MDR bacteriuria preoperatively was a reliable factor to predict sepsis.
描述鸟粪石结石的临床特征，并确定行经皮肾镜碎石术（PCNL）治疗的鸟粪石患者发生脓毒症的术前预测因子。
对 2011 年 4 月至 2018 年 3 月期间接受 PCNL 的患者进行回顾性研究。对符合条件的鸟粪石结石组和非鸟粪石结石组患者的数据进行倾向性评分匹配比较。随后，根据脓毒症 3 定义将鸟粪石结石组进一步分为非脓毒症和脓毒症组进行亚组分析。
基于年龄、性别、BMI 和通道数量进行匹配后，对比分析显示，鹿角状结石和较高的 Guy 结石评分更常出现在非鸟粪石结石患者（n=97）中，而非鸟粪石结石患者中更常见的是尿路结石手术史（56.70%）、术前广谱抗生素治疗（53.61%）、术前尿液培养阳性（55.67%）和术后脓毒症（35.05%）（均 P 值<0.05）。18 例（18.56%）患者存在多重耐药菌尿。多变量分析表明，术前存在多重耐药菌尿（OR=3.203；P=0.043）和血清肌酐升高（OR=3.963；P=0.010）是脓毒症的独立危险因素。利用这两个因素构建了一个预测脓毒症概率的列线图。该列线图具有良好的校准度和中等的判别能力（一致性指数：0.711）。
本研究表明，鸟粪石结石患者术后结石复发和脓毒症的风险显著增加。术前存在多重耐药菌尿是预测脓毒症的可靠因素。
