Lu Xun, Chen Qi, Wang Lixia, Zhu Haobo, Huang Liqu, Zhou Jincai, Guo Yunfei
Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China.
Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
BMC Urol. 2025 May 13;25(1):122. doi: 10.1186/s12894-025-01808-5.
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).
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).
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%.
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.
评估小儿腹腔镜肾盂成形术（LP）后双J（DJ）支架取出术后炎症生物标志物与发热性尿路感染（fUTI）患病率之间的关联。
对2021年9月至2024年11月因原发性输尿管肾盂连接部梗阻（UPJO）接受LP后行DJ支架取出术的儿科患者进行回顾性研究。记录基线特征、术前数据和fUTI的发生率。计算包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和全身免疫炎症指数（SII）在内的炎症指标。还确定了培养病原体的结果。进行单因素和多因素逻辑分析以确定DJ支架取出术后fUTI的潜在危险因素。通过受试者工作特征曲线（ROC）确定潜在危险因素的预测价值。
总体而言，295例患者纳入研究。DJ支架取出术后22例患者（7.5%）发生fUTI。与非fUTI组相比，fUTI组患者年龄更小（P = 0.008）且体重更低（P = 0.003）。此外，fUTI组血小板和中性粒细胞水平较高，淋巴细胞水平较低。fUTI患者中最常见的病原体是肠球菌和大肠杆菌。多因素逻辑分析显示，年龄（OR = 0.978，95%CI：0.956 - 0.999，P = 0.047）、如厕训练状态（OR = 0.297，95%CI：0.109 - 0.807，P = 0.017）和较高的PLR水平（OR = 1.101，95%CI：1.005 - 1.022，P = 0.002）是DJ支架取出术后fUTI的预测因素。PLR具有较高的预测价值，AUC为0.827，敏感性为90.91%，特异性为69.23%。
PLR是DJ支架取出术后诊断fUTI的有前景的预测指标。DJ支架取出术前PLR水平较高的患者应密切监测。未来需要进一步设计良好的前瞻性队列研究来探讨DJ取出术后PLR与fUTI之间的因果关系。
