Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Urolithiasis. 2022 Aug;50(4):455-464. doi: 10.1007/s00240-022-01318-1. Epub 2022 Feb 24.
The purpose of this study was to determine the plausibility and utility of utilizing a modified SOFA (mSOFA) score for predicting uroseptic shock after mini-percutaneous nephrolithotomy. A cohort of 707 patients who received mini-PCNL from August 2019 to December 2020 was retrospectively evaluated. The area under receiver operating characteristic curve (AUROC) was used to compare the predictive value of septic shock between mSOFA, systemic inflammatory response syndrome (SIRS) and qSOFA. Among 707 patients, 24 patients experienced uroseptic shock after mini-PCNL. Compared with the no uroseptic shock group, the proportion of females and rates of preoperative urine culture, renal pelvis urine culture and stone culture positivity were higher in the uroseptic shock group, with high levels of preoperative C-reactive protein (CRP) and postoperative procalcitonin (PCT). In the uroseptic shock group, the mSOFA score increased by two or more points in 83.3%; 79.2% had at least two SIRS criteria, and 100% had a qSOFA score of at least one point. mSOFA score (AUROC = 0.866, 95% CI: 0.779-0.954) exhibited greater discrimination for uroseptic shock after PCNL than SIRS (AUROC = 0.838, 95% CI: 0.742-0.943) and qSOFA (AUROC = 0.851, 95% CI: 0.811-0.892). In conclusion, the predictive value of the modified SOFA score for uroseptic shock after mini-PCNL was greater than that of the qSOFA score or SIRS.
本研究旨在确定改良 SOFA（mSOFA）评分预测微创经皮肾镜取石术后尿脓毒症性休克的合理性和实用性。回顾性分析了 2019 年 8 月至 2020 年 12 月接受微创经皮肾镜取石术的 707 例患者。采用受试者工作特征曲线（AUROC）比较 mSOFA、全身炎症反应综合征（SIRS）和 qSOFA 预测术后脓毒症性休克的价值。在 707 例患者中，24 例患者在微创经皮肾镜取石术后发生尿脓毒症性休克。与无尿脓毒症性休克组相比，尿脓毒症性休克组女性比例及术前尿培养、肾盂尿培养、结石培养阳性率较高，术前 C 反应蛋白（CRP）和术后降钙素原（PCT）水平较高。在尿脓毒症性休克组，2 分以上 mSOFA 评分增加 2 分以上者占 83.3%；至少有 2 项 SIRS 标准者占 79.2%，qSOFA 评分至少 1 分者占 100%。mSOFA 评分（AUROC=0.866，95%CI：0.779-0.954）对 PCNL 后尿脓毒症性休克的预测价值大于 SIRS（AUROC=0.838，95%CI：0.742-0.943）和 qSOFA（AUROC=0.851，95%CI：0.811-0.892）。总之，改良 SOFA 评分预测微创经皮肾镜取石术后尿脓毒症性休克的预测价值大于 qSOFA 评分或 SIRS。
