Association between platelet to lymphocyte ratio and febrile urinary tract infection after double-J stent removal in children underwent laparoscopic pyeloplasty.

OBJECTIVE

To evaluate the association between the inflammatory biomarkers and the prevalence of febrile urinary tract infection (fUTI) after double-J (DJ) stent removal in pediatrics following laparoscopic pyeloplasty (LP).

METHODS

A retrospective study was conducted in pediatrics underwent DJ stent removal following LP owing to primary ureteropelvic junction obstruction (UPJO) between September 2021 and November 2024. Baseline characteristics, preoperative data and the incidence of fUTI were documented. The inflammatory index including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) were calculated. The results of cultured pathogens were also identified. The univariate and multivariate logistic analysis were conducted to determine the potential risk factors of fUTI after DJ stent removal. The predictive value of potential risk factors were determined by receiver operating characteristic curve (ROC).

RESULTS

Overall, 295 patients were included in the study. fUTI occurred in 22 patients (7.5%) after DJ stent removal. Patients in the fUTI group were younger (P = 0.008) and had lower body weight (P = 0.003) compared to non-fUTI group. Additionally, the fUTI group showed higher levels of platelets and neutrophils, associated with lower levels of lymphocytes. The most commonly identified pathogens were Enterococcus and Escherichia coli in fUTI patients. Multivariate logistic analysis revealed that age (OR = 0.978, 95% CI: 0.956-0.999, P = 0.047), toilet training status (OR = 0.297, 95% CI: 0.109-0.807, P = 0.017) and higher levels of PLR (OR = 1.101, 95% CI: 1.005-1.022, P = 0.002) were predictive factors for fUTI after DJ stent removal. PLR had a high predictive value with an AUC of 0.827 with the sensitivity of 90.91% and the specificity of 69.23%.

CONCLUSION

PLR is a promising predictor for diagnosing fUTI after DJ stent removal. Patients with higher levels of PLR before DJ stent removal should be closely monitored. Further well-designed and prospective cohorts are required in future to explore the cause-and-effect relationship between PLR and fUTI after DJ removal.