Department of Urology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China.
Urolithiasis. 2021 Feb;49(1):65-72. doi: 10.1007/s00240-020-01190-x. Epub 2020 May 5.
The study aims to identify whether gender differences exist in the sequential organ failure assessment (SOFA) score to the extent of affecting its predictive accuracy for septic shock after percutaneous nephrolithotomy (PCNL). A retrospective study of 612 patients undergoing PCNL was performed. The SOFA scores of male and female groups were compared to identify any gender differences. The ROC curve was used to find differences between the original and adjusted SOFA scores. Postoperative septic shock developed in 21 (3.43%) cases. A marginally significant discrepancy in median SOFA scores between genders was discovered in a subgroup of patients < 40 years old (p = 0.048). A gender difference existed in the SOFA score after PCNL, with greater proportion of high scores in female patients (p = 0.011). Male patients had a higher proportion of ≥ 2 sub-score in hepatic and renal systems than female patients, caused by their higher preoperative bilirubin and creatinine (p < 0.05). An adjusted SOFA score was created to replace the original postoperative SOFA score with the perioperative changed values of bilirubin and creatinine. Performance of the adjusted SOFA score for predicting septic shock was comparable with the original SOFA score (AUC 0.987 vs. 0.985, p = 0.932). Under the premise of ensuring 100% sensitivity, the adjusted SOFA score reduced the 43.7% (31/71) false-positive rate for predicting septic shock compared with the original SOFA score. In conclusion, the gender should not be neglected when applying SOFA score for patients after PCNL. The adjusted SOFA score eliminates negative effects caused by gender differences in predicting septic shock.
本研究旨在确定在经皮肾镜碎石取石术（PCNL）后发生感染性休克的情况下，序贯器官衰竭评估（SOFA）评分是否存在性别差异，以及这种差异对其预测准确性的影响程度。我们对 612 例行 PCNL 的患者进行了回顾性研究。比较了男性和女性组的 SOFA 评分，以确定是否存在性别差异。使用 ROC 曲线来发现原始和调整后的 SOFA 评分之间的差异。术后发生感染性休克的患者有 21 例（3.43%）。在年龄<40 岁的亚组患者中，发现性别间 SOFA 评分的中位数存在显著差异（p=0.048）。PCNL 后 SOFA 评分存在性别差异，女性患者中高分的比例较高（p=0.011）。与女性患者相比，男性患者的肝、肾功能系统中≥2 个子评分的比例更高，这是由于他们术前的胆红素和肌酐较高（p<0.05）。创建了一个调整后的 SOFA 评分，用胆红素和肌酐的围手术期变化值替代原始的术后 SOFA 评分。调整后的 SOFA 评分预测感染性休克的性能与原始 SOFA 评分相当（AUC 0.987 与 0.985，p=0.932）。在保证 100%灵敏度的前提下，与原始 SOFA 评分相比，调整后的 SOFA 评分降低了预测感染性休克的 43.7%（31/71）的假阳性率。总之，在应用 SOFA 评分预测 PCNL 后患者的病情时，不应忽视性别因素。调整后的 SOFA 评分消除了性别差异对预测感染性休克的负面影响。
