Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, People's Republic of China.
Urolithiasis. 2023 Mar 2;51(1):42. doi: 10.1007/s00240-023-01417-7.
The risk factors of complications after SWL are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting major complications after extracorporeal shockwave lithotripsy (SWL) in patients with ureteral stones. The development cohort included 1522 patients with ureteral stones who underwent SWL between June 2020 and August 2021 in our hospital. Five hundred and fifty-three patients with ureteral stones participated in the validation cohort from September 2020 to April 2022. The data were prospectively recorded. Backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 7.2% (110/1522) of patients in the development cohort and 8.7% (48/553) of those in the validation cohort suffered from major complications. We identified five predictive factors for major complications: age, gender, stone size, Hounsfield unit of stone, and hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic curves of 0.885 (0.872-0.940) and good calibration (P = 0.139). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that older age, female gender, higher Hounsfield unit, size, and grade of hydronephrosis were risk predictors of major complications after SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of high-risk patients may decrease postoperative morbidity.
冲击波碎石术（SWL）后并发症的风险因素尚不清楚。因此，基于一项大型前瞻性队列研究，我们旨在开发和验证一个列线图，以预测输尿管结石患者 SWL 后主要并发症的发生。该研究的开发队列纳入了 2020 年 6 月至 2021 年 8 月期间在我院接受 SWL 治疗的 1522 例输尿管结石患者。2020 年 9 月至 2022 年 4 月期间，共有 553 例输尿管结石患者参与了验证队列。数据前瞻性记录。使用似然比检验，以赤池信息量准则（Akaike's information criterion）为停止规则，进行向后逐步选择。评估该预测模型的临床有效性、校准度和区分度。最终，开发队列中有 7.2%（110/1522）的患者和验证队列中有 8.7%（48/553）的患者发生了主要并发症。我们确定了五个主要并发症的预测因素：年龄、性别、结石大小、结石的亨氏单位（Hounsfield unit）和肾积水程度。该模型的曲线下面积（area under the receiver operating characteristic curves，AUC）为 0.885（0.872-0.940），具有良好的区分度，校准度较好（P=0.139）。决策曲线分析表明该模型具有临床价值。在这项大型前瞻性队列研究中，我们发现年龄较大、女性、亨氏单位较高、结石较大、肾积水程度较高是 SWL 后发生主要并发症的风险预测因素。该列线图将有助于术前风险分层，为每位患者提供个体化的治疗建议。此外，早期识别和适当管理高危患者可能会降低术后发病率。
