Amier Yirixiatijiang, Zhang Yucong, Zhang Jiaqiao, Yao Weimin, Wang Shaogang, Wei Chao, Yu Xiao
Department of Urology, and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Geriatric, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Endourol. 2022 Mar;36(3):292-297. doi: 10.1089/end.2021.0406.
To assess the preoperative risk factors for postoperative urosepsis after mini-percutaneous nephrolithotomy (mPCNL) in patients with large kidney stones. Records of 171 patients with large (≥30 mm) kidney stones who underwent mPCNL from December 2013 to October 2019 were reviewed. Demographic data of patients, preoperative urine analysis, urine culture, and routine blood tests and abdominal computerized cosmography data were collected and analyzed. A predictive nomogram model was established based on the results of logistic regression. Twenty-nine patients (17%) developed postoperative urosepsis in this study. Univariate analysis demonstrated that preoperative urine leukocytes ( < 0.001), urine nitrite ( < 0.001), stones in adjacent calices on the coronal plane ( < 0.001), the maximum cross-sectional area of stones ( < 0.001), the diameter of hydronephrosis ( = 0.010), and number of stones ( = 0.044) were associated with postoperative urosepsis after mPCNL in patients with large kidney stones. And preoperative urine leukocytes ≥450/μL ( = 0.002) was the only independent risk factor for postoperative urosepsis in multivariate logistic regression analysis. Based on the results of multivariate regression, a nomogram model was established for the prediction of postoperative urosepsis with ideal discrimination (area under receiver operating characteristic curve was 0.867). Patients with certain preoperative characteristics, including higher urine leukocytes, positive urine nitrite, stones in adjacent calices on the coronal plane, larger maximum cross-sectional area of stones, larger diameter of hydronephrosis, and larger number of stones, who received mPCNL may have a higher risk of postoperative urosepsis. A predictive model can help urologists identify patients who may develop postoperative urosepsis with high probability.
评估大肾结石患者微创经皮肾镜取石术（mPCNL）后发生术后尿脓毒症的术前危险因素。回顾了2013年12月至2019年10月期间171例接受mPCNL的大（≥30mm）肾结石患者的记录。收集并分析患者的人口统计学数据、术前尿液分析、尿培养、常规血液检查和腹部计算机断层扫描数据。基于逻辑回归结果建立了预测列线图模型。本研究中有29例患者（17%）发生了术后尿脓毒症。单因素分析表明，术前尿白细胞（<0.001）、尿亚硝酸盐（<0.001）、冠状面上相邻肾盏结石（<0.001）、结石最大横截面积（<0.001）、肾积水直径（=0.010）和结石数量（=0.044）与大肾结石患者mPCNL术后尿脓毒症相关。在多因素逻辑回归分析中，术前尿白细胞≥450/μL（=0.002）是术后尿脓毒症的唯一独立危险因素。基于多因素回归结果，建立了用于预测术后尿脓毒症的列线图模型，其具有理想的区分度（受试者操作特征曲线下面积为0.867）。具有某些术前特征（包括尿白细胞较高、尿亚硝酸盐阳性、冠状面上相邻肾盏结石、结石最大横截面积较大、肾积水直径较大和结石数量较多）的患者接受mPCNL后，术后发生尿脓毒症的风险可能更高。预测模型可帮助泌尿外科医生识别术后可能发生尿脓毒症的高概率患者。
