Cormio Angelo, Castellani Daniele, Ratnayake Runeel, De Palma Domenico, Fiorella Ruggiero, De Gennaro Alessio, Auciello Mario, Albino Giuseppe, Busetto Gian Maria, Carrieri Giuseppe, Cormio Luigi
Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy.
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, Ancona, 60126, Italy.
World J Urol. 2025 Aug 14;43(1):493. doi: 10.1007/s00345-025-05878-w.
To evaluate association between postoperative serum procalcitonin (PCT) levels and infectious complications following mini-percutaneous nephrolithotomy (mini-PCNL), and to identify predictors of elevated PCT.
We retrospectively analyzed 496 adult patients who underwent mini-PCNL for kidney stones (February 2020-March 2025). Patients were stratified into four groups based on postoperative fever occurrence and PCT levels (≤ 2.0 ng/ml vs. > 2.0 ng/ml): Group 1 (no fever, low PCT, n = 404), Group 2 (fever, low PCT, n = 10), Group 3 (no fever, high PCT, n = 65), and Group 4 (fever, high PCT, n = 17). Multivariable logistic regression analysis identified factors associated with PCT levels > 2.0 ng/ml.
Elevated PCT occurred in 82 patients (16.5%). Groups 3 and 4 had significantly higher rates of positive preoperative urine cultures (46.2% and 64.7%) compared to Groups 1 and 2 (6.2% and 30%, p < 0.001). Positive stone cultures were more frequent in Group 3 (50.8%). Median PCT level was higher in Group 4 [38.00 (13.10-87.70) ng/mL] compared with Group 3 [18.10 (8.60-54.0) ng/mL]. Major infectious complications (Clavien ≥ 3) occurred exclusively in Group 4, including one sepsis-related death. Multivariable analysis revealed that positive preoperative urine culture (OR 6.72 95% CI 3.20-14.14) and stone culture (OR 4.83 95% CI 2.34-9.81) were independent predictors of elevated PCT.
Elevated PCT following mini-PCNL is associated with positive preoperative urine and stone cultures, regardless of fever presence. Several patients exhibit elevated PCT without clinical manifestation of infection, suggesting a subclinical infection. These findings support the integration of PCT for enhanced risk stratification and postoperative management following mini-PCNL.
评估微创经皮肾镜取石术（mini-PCNL）后血清降钙素原（PCT）水平与感染性并发症之间的关联，并确定PCT升高的预测因素。
我们回顾性分析了496例接受mini-PCNL治疗肾结石的成年患者（2020年2月至2025年3月）。根据术后发热情况和PCT水平（≤2.0 ng/ml与>2.0 ng/ml）将患者分为四组：第1组（无发热，PCT低，n = 404），第2组（发热，PCT低，n = 10），第3组（无发热，PCT高，n = 65），第4组（发热，PCT高，n = 17）。多变量逻辑回归分析确定了与PCT水平>2.0 ng/ml相关的因素。
82例患者（16.5%）出现PCT升高。与第1组和第2组（6.2%和30%）相比，第3组和第4组术前尿培养阳性率显著更高（46.2%和64.7%，p < 0.001）。第3组结石培养阳性更为常见（50.8%）。第4组的PCT中位数水平[38.00（13.10 - 87.70）ng/mL]高于第3组[18.10（8.60 - 54.0）ng/mL]。主要感染性并发症（Clavien≥3级）仅发生在第4组，包括1例与脓毒症相关的死亡。多变量分析显示，术前尿培养阳性（OR 6.72，95%CI 3.20 - 14.14）和结石培养阳性（OR 4.83，95%CI 2.34 - 9.81）是PCT升高的独立预测因素。
mini-PCNL后PCT升高与术前尿和结石培养阳性相关，无论是否发热。一些患者PCT升高但无感染的临床表现，提示存在亚临床感染。这些发现支持将PCT纳入以加强mini-PCNL后的风险分层和术后管理。
