Gao Chuanyu, Peters Max, Kurver Piet, Anbarasan Thineskrishna, Jayaraajan Keerthanaa, Manning Todd, Cashman Sophia, Nambiar Arjun, Cumberbatch Marcus, Lamb Benjamin W, Pickard Robert, Erotocritou Paul, Smith Daron, Kasivisvanathan Veeru, Shah Taimur T
British Urology Researchers in Surgical Training (BURST), London, United Kingdom.
Department of Radiation Oncology, Cancer Centre, University Medical Centre Utrecht.
BJU Int. 2022 Jun 28;130(6):823-31. doi: 10.1111/bju.15839.
To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management.
SUBJECT/PATIENTS: A 2517 patient dataset was utilised from an international multi-centre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflammatory Markers In Patients Presenting with Acute Ureteric Colic) of patients presenting with acute ureteric colic across 71 secondary care hospitals in the United Kingdom, Ireland, Australia, and New Zealand. Inclusion criteria mandated a non-contrast CT-KUB.
SSP was defined as the 'absence of the need for intervention'. The model was developed using logistic regression and backwards selection (to achieve lowest AIC) in a subset from 2009-2015 (n=1728) and temporally validated on a subset from 2016-2017 (n=789).
Of the 2517 patients, 1874 had SSP (74.5%). Mean age (±[SD]) was 47 (±14.7) years and 1892 were male (75.2%). At the end of the modelling process, gender: male (OR 0.8, 95%CI 0.64-1.01, p=0.07), neutrophil count (OR 1.03, 95%CI 1.00-1.06, p = 0.08), hydronephrosis (OR 0.79, 95%CI 0.59-1.05, p=0.1), hydroureter (OR 1.3, 95%CI 0.97-1.75, p =0.08), stone size >5-7mm (OR 0.2, 95%CI 0.16-0.25, p<0.0001), stone size >7mm (OR 0.11, 95%CI 0.08-0.15, p<0.001), middle ureter stone position (OR 0.59, 95%CI 0.43-0.81, p=0.001), upper ureter stone position (OR 0.31, 95%CI 0.25-0.39, p<0.001) ), medical expulsive therapy use (OR 1.36, 95%CI 1.1 - 1.67, p = 0.001), oral NSAID use (OR 1.3, 95%CI 0.99 - 1.71, p=0.06), and rectal NSAID use (OR1.17, 95%CI 0.9 - 1.53, p=0.24) remained. Concordance-statistic (C-statistic) was 0.77 (95%CI 0.75 - 0.80) and a nomogram was developed based on these.
The presented nomogram is available to use as an online calculator via www.BURSTurology.com and could allow clinicians and patients to make a more informed decision on pursuing conservative management versus early intervention.
开发一种列线图，以预测适合保守治疗的急性输尿管绞痛患者的结石自然排出情况（SSP）。
研究对象/患者：使用了来自一项国际多中心队列研究（MIMIC，一项评估炎症标志物在急性输尿管绞痛患者中作用的多中心队列研究）的2517例患者数据集，这些患者来自英国、爱尔兰、澳大利亚和新西兰的71家二级医疗机构，均患有急性输尿管绞痛。纳入标准要求进行非增强CT-KUB检查。
SSP定义为“无需干预”。该模型在2009年至2015年的一个子集中（n = 1728）使用逻辑回归和向后选择法（以达到最低AIC）进行开发，并在2016年至2017年的一个子集中（n = 789）进行时间验证。
2517例患者中，1874例出现结石自然排出（74.5%）。平均年龄（±[标准差]）为47（±14.7）岁，男性1892例（75.2%）。在建模过程结束时，性别：男性（比值比0.8，95%置信区间0.64 - 1.01，p = 0.07）、中性粒细胞计数（比值比1.03，95%置信区间1.00 - 1.06，p = 0.08）、肾积水（比值比0.79，95%置信区间0.59 - 1.05，p = 0.1）、输尿管积水（比值比1.3，95%置信区间0.97 - 1.75，p = 0.08）、结石大小>5 - 7mm（比值比0.2，95%置信区间0.16 - 0.25，p < 0.0001）、结石大小>7mm（比值比0.11，95%置信区间0.08 - 0.15，p < 0.001）、输尿管中段结石位置（比值比0.59，95%置信区间0.43 - 0.81，p = 0.001）、输尿管上段结石位置（比值比0.31，95%置信区间0.25 - 0.39，p < 0.001）、使用药物排石疗法（比值比1.36，95%置信区间1.1 - 1.67，p = 0.001）、口服非甾体抗炎药（比值比1.3，95%置信区间0.99 - 1.71，p = 0.06）和直肠使用非甾体抗炎药（比值比1.17，95%置信区间0.9 - 1.53，p = 0.24）仍被保留。一致性统计量（C统计量）为0.77（95%置信区间0.75 - 0.80），并据此开发了列线图。
所呈现的列线图可通过www.BURSTurology.com作为在线计算器使用，能够让临床医生和患者在选择保守治疗还是早期干预时做出更明智的决策。
