Kalyenci Bedreddin, Çoban Ferhat, Sulhan Hasan, Yücel Mehmet Özgür, Benlioğlu Can, Kaz Gazi, Şahinkanat Tayfun, Çift Ali
Department of Urology, Faculty of Medicine, Adıyaman University, 02040, Adıyaman, Turkey.
Adıyaman University Central, Campus Faculty of Medicine Dean's Office Altınşehir/Center/Adıyaman, Adıyaman, Turkey.
BMC Urol. 2025 Jul 14;25(1):168. doi: 10.1186/s12894-025-01859-8.
To predict postoperative infectious complications by utilizing hemogram parameters and derived inflammation indices and to analyze patient-related risk factors to propose a nomogram.
The data of patients who underwent retrograde intrarenal surgery were reviewed. The patients were categorized into two groups: those without infectious complications (Group A) and those with infectious complications (Group B). Infectious complications were defined as fever persisting above 38 °C for 48 h and the presence of two or more systemic inflammatory response syndrome (SIRS) criteria. Hemogram parameters and inflammation indices were examined to predict infectious complications. The study utilized neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), along with the pan-immune-inflammation value (PIV) and systemic immune-inflammation index (SII).
The data of 658 cases were evaluated. No infectious complications were observed in 610 cases (92.7%), while 33 cases (5.0%) developed fever, and 15 cases (2.3%) met the criteria for SIRS. The optimal cut-off values for distinguishing between groups were determined as follows: >2.66 for NLR, > 122.5 for PLR, < 2.81 for LMR, > 619.4 for SII, and > 500.2 for PIV. Patients with PIV > 500.2 exhibited a 13.737-fold increase (95% confidence interval [CI]: 7.260-25.994) in infectious complications compared to those with PIV ≤ 500.2, making PIV the strongest predictor. The most significant factors in differentiating between the groups were, in order of importance, Charlson comorbidity index, stone volume, preoperative serum creatinine level, and preoperative double-J stent placement. These factors were analyzed using multivariate logistic regression alongside PIV and SII, and two models were constructed. The predictive power of Model 1 was determined as Cox & Snell R² = 0.269 and Nagelkerke R² = 0.661, while Model 2 had a Cox & Snell R² value of 0.264 and a Nagelkerke R² value of 0.648.
PIV and SII, derived from hemogram parameters, serve as predictive inflammatory indices for postoperative infectious complications. They provide valuable preoperative insight into the patient's immune and systemic inflammatory responses. When combined with other risk factors, these indices allow for the prediction of postoperative infectious complications.
利用血常规参数和衍生的炎症指标预测术后感染性并发症，并分析患者相关危险因素以构建列线图。
回顾性分析接受逆行肾内手术患者的数据。将患者分为两组：无感染性并发症组（A组）和有感染性并发症组（B组）。感染性并发症定义为发热持续超过38℃达48小时且符合两项或更多全身炎症反应综合征（SIRS）标准。检测血常规参数和炎症指标以预测感染性并发症。本研究采用中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR），以及全免疫炎症值（PIV）和全身免疫炎症指数（SII）。
评估了658例患者的数据。610例（92.7%）未观察到感染性并发症，33例（5.0%）出现发热，15例（2.3%）符合SIRS标准。区分两组的最佳截断值确定如下：NLR>2.66，PLR>122.5，LMR<2.81，SII>619.4，PIV>500.2）。与PIV≤500.2的患者相比，PIV>500.2的患者发生感染性并发症的风险增加13.737倍（95%置信区间[CI]：7.260 - 25.994），使PIV成为最强的预测指标。区分两组的最重要因素按重要性排序依次为Charlson合并症指数、结石体积、术前血清肌酐水平和术前双J管置入。使用多因素逻辑回归分析这些因素以及PIV和SII，并构建了两个模型。模型1的预测能力确定为Cox & Snell R² = 0.269，Nagelkerke R² = 0.661，而模型2的Cox & Snell R²值为0.264，Nagelkerke R²值为0.648。
源自血常规参数的PIV和SII可作为术后感染性并发症的预测性炎症指标。它们为术前了解患者的免疫和全身炎症反应提供了有价值的信息。当与其他危险因素结合时，这些指标可用于预测术后感染性并发症。
