Qiu Teng, Hu Xiao-Tao
Department of Urology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China.
Department of Plastic Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China.
J Coll Physicians Surg Pak. 2024 Dec;34(12):1478-1483. doi: 10.29271/jcpsp.2024.12.1478.
To evaluate major bleeding risk factors in percutaneous nephrolithotomy (PCNL) for upper urinary tract calculi and validate a prediction model.
Analytical study. Place and Duration of the Study: The First Affiliated Hospital of Wannan Medical College, Wuhu, China, from January 2019 to August 2023.
Major bleeding was defined as a decrease in haemoglobin of ≥20 g/L compared to preoperative levels. A retrospective analysis of 468 PCNL patients identified risk factors for major bleeding using univariate, LASSO, and logistic regression analyses. Nomogram models were developed using R software, with ROC and calibration plots assessing the model's accuracy. The bootstrap method provided internal validation, and DCA evaluated clinical utility.
Independent risk factors included diabetes (OR = 4.17), staghorn calculi (OR = 3.41), operative duration (OR = 1.01), and staged surgery (OR = 2.75). The model showed high discriminative ability (C-statistic: 0.783) and alignment with observed outcomes. Internal validation confirmed robustness (C-statistic: 0.728).
The predictive model for major bleeding during and after PCNL, focusing on diabetes, staghorn calculi, operative duration, and staged surgery, is highly accurate, aiding in the PCNL risk assessment.
Upper urinary tract calculi, Percutaneous nephrolithotomy, Major bleeding, Risk factors, Prediction model.
评估上尿路结石经皮肾镜取石术（PCNL）中大出血的危险因素，并验证一个预测模型。
分析性研究。研究地点和时间：中国芜湖皖南医学院第一附属医院，2019年1月至2023年8月。
大出血定义为血红蛋白较术前水平下降≥20 g/L。对468例PCNL患者进行回顾性分析，采用单因素分析、LASSO分析和逻辑回归分析确定大出血的危险因素。使用R软件建立列线图模型，通过ROC曲线和校准图评估模型的准确性。采用自助法进行内部验证，DCA评估临床实用性。
独立危险因素包括糖尿病（OR = 4.17）、鹿角形结石（OR = 3.41）、手术时间（OR = 1.01）和分期手术（OR = 2.75）。该模型显示出较高的判别能力（C统计量：0.783），且与观察结果相符。内部验证证实了模型的稳健性（C统计量：0.728）。
聚焦于糖尿病、鹿角形结石、手术时间和分期手术的PCNL术中及术后大出血预测模型高度准确，有助于PCNL的风险评估。
上尿路结石；经皮肾镜取石术；大出血；危险因素；预测模型
