Cheng Lve, Niu Junwei, Cheng Yao, Liu Jie, Shi Mengjia, Huang Shijia, Ding Xiong, Li Shengwei
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
J Inflamm Res. 2024 Apr 25;17:2575-2587. doi: 10.2147/JIR.S453653. eCollection 2024.
There is a lack of validated predictive models for the occurrence of systemic inflammatory response syndrome (SIRS) after percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for the treatment of hepatolithiasis. This is the first study to estimate the incidence of SIRS after PTCSL.
A retrospective analysis of 284 PTCSL sessions for the treatment of hepatolithiasis at our institution between January 2019 and January 2023 was performed. The development of SIRS after PTCSL was the primary study endpoint. Independent risk factors for SIRS after PTCSL were identified using univariate and multivariate logistic regression analyses. A nomogram prediction model was constructed using these independent risk factors, and the predictive value was assessed using receiver operating characteristic (ROC) curves.
The incidence of SIRS after PTCSL was 20.77%. According to multivariate analysis, the number of PTCSL sessions (odds ratio [OR]=0.399, 95% confidence interval [CI]=0.202-0.786, p=0.008), stone location (OR=2.194, 95% CI=1.107-4.347, p=0.024), intraoperative use of norepinephrine (OR=0.301, 95% CI=0.131-0.689, p=0.004), intraoperative puncture (OR=3.476, 95% CI=1.749-6.906, P<0.001), preoperative gamma-glutamyltransferase (OR=1.002, 95% CI=1.001-1.004, p=0.009), and preoperative total lymphocyte count (OR=1.820, 95% CI=1.110-2.985, p=0.018) were found to be independent risk factors for the development of SIRS after PTCSL. These six independent risk factors were used to construct a nomogram prediction model, which showed satisfactory accuracy with an area under the ROC curve of 0.776 (95% CI: 0.702-0.850).
The number of PTCSL sessions, stone location, intraoperative use of norepinephrine, intraoperative puncture, preoperative gamma-glutamyltransferase, and preoperative total lymphocyte count may predict the occurrence of SIRS after PTCSL. This prediction model may help clinicians identify high-risk patients in advance.
对于经皮经肝胆道镜碎石术（PTCSL）治疗肝内胆管结石后发生全身炎症反应综合征（SIRS），缺乏经过验证的预测模型。这是第一项评估PTCSL术后SIRS发生率的研究。
对2019年1月至2023年1月在本机构进行的284例PTCSL治疗肝内胆管结石的病例进行回顾性分析。PTCSL术后SIRS的发生是主要研究终点。采用单因素和多因素逻辑回归分析确定PTCSL术后SIRS的独立危险因素。使用这些独立危险因素构建列线图预测模型，并通过受试者操作特征（ROC）曲线评估其预测价值。
PTCSL术后SIRS的发生率为20.77%。多因素分析显示，PTCSL的次数（比值比[OR]=0.399，95%置信区间[CI]=0.202-0.786，p=0.008）、结石位置（OR=2.194，95%CI=1.107-4.347，p=0.024）、术中使用去甲肾上腺素（OR=0.301，95%CI=0.131-0.689，p=0.004）、术中穿刺（OR=3.476，95%CI=1.749-6.906，P<0.001）以及术前γ-谷氨酰转移酶（OR=1.002，95%CI=1.001-1.004，p=0.009）和术前总淋巴细胞计数（OR=1.820，95%CI=1.110-2.985，p=0.018）是PTCSL术后发生SIRS的独立危险因素。利用这六个独立危险因素构建了列线图预测模型，其ROC曲线下面积为0.776（95%CI：0.702-0.850），显示出令人满意的准确性。
PTCSL的次数、结石位置、术中使用去甲肾上腺素、术中穿刺、术前γ-谷氨酰转移酶和术前总淋巴细胞计数可能预测PTCSL术后SIRS的发生。该预测模型可能有助于临床医生提前识别高危患者。
