Cheng Lve, Ding Xiong, Liu Jie, Shi Mengjia, Huang Shijia, Niu Junwei, Li Shengwei, Cheng Yao
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
J Inflamm Res. 2025 May 13;18:6203-6216. doi: 10.2147/JIR.S513678. eCollection 2025.
Sepsis is a possible complication of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for hepatolithiasis, but risk assessment tools are lacking. This study aimed to identify predictors of sepsis after PTCSL and develop a predictive nomogram.
In this nested case‒control study, the data from 298 patients who underwent 528 PTCSL sessions between 1 January 2016 and 1 July 2024 were retrospectively reviewed. All sessions demonstrating sepsis complications were included in the sepsis group. For each session in the sepsis group, two treatment date-matched sessions not demonstrating sepsis were randomly selected via a nested case‒control design. All the matched sessions were divided into training and validation sets. Least absolute shrinkage and selection operator (LASSO) analysis was conducted to preliminarily select predictors of sepsis complications. Multivariable logistic regression was performed to identify factors for constructing the nomogram.
Sepsis was diagnosed in 46 patients (53 sessions), for an incidence of 10.69% (53 among 496 sessions). Three characteristic variables were included in the model: operation technique (odds ratio [OR]=0.170, 95% confidence interval [CI]: 0.048-0.599, P=0.006), cirrhosis (OR=3.769, 95% CI: 1.474-9.638, P=0.006), and postoperative prophylactic dexamethasone (OR=0.267, 95% CI: 0.101-0.703, P=0.008). The area under the curve (AUC) for the nomogram was 0.756 (95% CI, 0.658-0.853) in the training set and 0.762 (95% CI, 0.618-0.906) in the validation set, demonstrating relatively high discriminability. The calibration curves demonstrated the consistency between the predicted and actual values. Decision curve analysis indicated that the nomogram offers net clinical benefits.
The operation technique, cirrhosis, and postoperative prophylactic dexamethasone may predict the occurrence of sepsis after PTCSL. We developed a nomogram to predict sepsis complications following PTCSL and demonstrated its relatively strong performance.
脓毒症是肝内胆管结石经皮经肝胆道镜碎石术（PTCSL）可能出现的并发症，但缺乏风险评估工具。本研究旨在确定PTCSL术后脓毒症的预测因素并建立预测列线图。
在这项巢式病例对照研究中，回顾性分析了2016年1月1日至2024年7月1日期间298例患者接受528次PTCSL治疗的数据资料。所有出现脓毒症并发症的治疗均纳入脓毒症组。对于脓毒症组中的每次治疗，通过巢式病例对照设计随机选择两个与之治疗日期匹配但未出现脓毒症的治疗。所有匹配的治疗被分为训练集和验证集。进行最小绝对收缩和选择算子（LASSO）分析以初步筛选脓毒症并发症的预测因素。采用多变量逻辑回归确定构建列线图的因素。
46例患者（53次治疗）被诊断为脓毒症，发生率为10.69%（496次治疗中有53次）。模型纳入三个特征变量：手术技术（比值比[OR]=0.170，95%置信区间[CI]：0.048-0.599，P=0.006）、肝硬化（OR=3.769，95%CI：1.474-9.638，P=0.006）以及术后预防性使用地塞米松（OR=0.267，95%CI：0.101-0.703，P=0.008）。训练集中列线图的曲线下面积（AUC）为0.756（95%CI，0.658-0.853），验证集中为0.762（95%CI，0.618-0.906），显示出较高的区分能力。校准曲线表明预测值与实际值之间具有一致性。决策曲线分析表明列线图具有临床净获益。
手术技术、肝硬化以及术后预防性使用地塞米松可能预测PTCSL术后脓毒症的发生。我们建立了一个预测PTCSL术后脓毒症并发症的列线图，并证明了其较强的性能。
