Sun Jian-Xuan, Xu Jin-Zhou, Liu Chen-Qian, Xun Yang, Lu Jun-Lin, Xu Meng-Yao, An Ye, Hu Jia, Li Cong, Xia Qi-Dong, Wang Shao-Gang
Department and Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
Front Surg. 2022 Apr 15;9:814293. doi: 10.3389/fsurg.2022.814293. eCollection 2022.
The postoperative sepsis is a latent fatal complication for both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PNL). An effective predictive model constructed by readily available clinical markers is urgently needed to reduce postoperative adverse events caused by infection. This study aims to determine the pre-operative predictors of sepsis in patients with unilateral, solitary, and proximal ureteral stones after fURS and PNL.
We retrospectively enrolled 910 patients with solitary proximal ureteral stone with stone size 10-20 mm who underwent fURS or PNL from Tongji Hospital's database, including 412 fURS cases and 498 PNL cases. We used the least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis to identify the risk factors for sepsis. Finally, a nomogram was assembled utilizing these risk factors.
In this study, 49 patients (5.4%) developed sepsis after fURS or PNL surgery. Lasso regression showed postoperative sepsis was associated with gender (female), pre-operative fever, serum albumin (<35 g/L), positive urine culture, serum WBC (≥10,000 cells/ml), serum neutrophil, positive urine nitrite and operation type (fURS). The multivariate logistic analysis indicated that positive urine culture (odds ratio [] = 5.9092, 95% [2.6425-13.2140], < 0.0001) and fURS ( = 1.9348, 95% [1.0219-3.6631], = 0.0427) were independent risk factors of sepsis and albumin ≥ 35g/L ( = 0.4321, 95% [0.2054-0.9089], = 0.0270) was independent protective factor of sepsis. A nomogram was constructed and exhibited favorable discrimination (area under receiver operating characteristic curve was 0.78), calibration [Hosmer-Lemeshow (HL) test = 0.904], and net benefits displayed by decision curve analysis (DCA).
Patients who underwent fURS compared to PNL or have certain pre-operative characteristics, such as albumin <35 g/L and positive urine culture, are more likely to develop postoperative sepsis. Cautious preoperative evaluation and appropriate operation type are crucial to reducing serious infectious events after surgery, especially for patients with solitary, unilateral, and proximal ureteral stones sized 10-20 mm.
术后脓毒症是输尿管软镜检查（fURS）和经皮肾镜取石术（PNL）潜在的致命并发症。迫切需要构建一种由易于获得的临床指标组成的有效预测模型，以减少感染引起的术后不良事件。本研究旨在确定fURS和PNL术后单侧、孤立性近端输尿管结石患者脓毒症的术前预测因素。
我们从同济医院数据库中回顾性纳入910例结石大小为10 - 20mm的孤立性近端输尿管结石患者，其中412例接受fURS，498例接受PNL。我们使用最小绝对收缩和选择算子（LASSO）回归和多因素逻辑回归分析来确定脓毒症的危险因素。最后，利用这些危险因素构建了列线图。
在本研究中，49例（5.4%）患者在fURS或PNL术后发生脓毒症。LASSO回归显示术后脓毒症与性别（女性）、术前发热、血清白蛋白（<35g/L）、尿培养阳性、血清白细胞（≥10,000个细胞/ml）、血清中性粒细胞、尿亚硝酸盐阳性及手术类型（fURS）有关。多因素逻辑分析表明，尿培养阳性（比值比[] = 5.9092，95%[2.6425 - 13.2140]，<0.0001）和fURS（= 1.9348，95%[1.0219 - 3.6631]，= 0.0427）是脓毒症的独立危险因素，白蛋白≥35g/L（= 0.4321, 95%[0.2054 - 0.9089]，= 0.0270）是脓毒症的独立保护因素。构建了列线图，其具有良好的区分度（受试者操作特征曲线下面积为0.78）、校准度[Hosmer - Lemeshow（HL）检验= 0.904]，决策曲线分析（DCA）显示了净效益。
与接受PNL的患者相比，接受fURS的患者或具有某些术前特征（如白蛋白<35g/L和尿培养阳性）的患者术后更易发生脓毒症。谨慎的术前评估和合适的手术类型对于减少术后严重感染事件至关重要，尤其是对于结石大小为10 - 20mm的孤立性、单侧性和近端输尿管结石患者。
