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Predictive factors for fever and sepsis following percutaneous nephrolithotomy: A review of 580 patients.

ABSTRACT: There has been much speculation and discussion about the infective complications of percutaneous nephrolithotomy (PCNL). While fever is common after PCNL, the incidence of it progressing to urosepsis is fortunately less. Which patient undergoing PCNL is at risk of developing urosepsis and in whom aggressive treatment of fever postoperatively may prevent the progression to severe sepsis becomes a very important question. This study aims to answer these vital questions.This is a single institutional, retrospective study over a period of 3 years.Retrospective analysis of medical records of the patients undergoing PCNL from August 2012 to July 2015 was done. A total of 580 patients were included in the study, and the study variables recorded were analyzed statistically.Statistical analysis was performed by Chi-square test.Three factors significantly correlated with postoperative severe sepsis, namely, stone size >25 mm, prolonged operative time >120 min, and significant bleeding requiring transfusion. Factors associated with fever after PCNL which did not progress to sepsis were the presence of staghorn calculi and multiple access tracts in addition to the factors listed above for sepsis.Fever after PCNL is not uncommon but it has a low incidence of progressing to life-threatening severe sepsis and multiorgan dysfunction syndrome. Special precautions and monitoring should be taken in patients with bigger stone (>25 mm) and patients with severe intraoperative hemorrhage requiring blood transfusion. It is better to stage the procedure rather than prolong the operative time (120 min). Identifying these factors and minimizing them may decrease the incidence of this life-threatening complication.

SUBMITTER: Bansal SS

PROVIDER: S-EPMC5532888 | biostudies-other | 2017 Jul-Sep

REPOSITORIES: biostudies-other

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Project description:Objectives: To investigate the factors associated with systemic infection after percutaneous nephrolithotomy (PCNL) and establish a predictive model to provide theoretical basis for the prevention of systemic inflammatory response syndrome (SIRS) and urosepsis correlate to percutaneous nephrostomy. Methods: Patients received PCNL between January 2016 and December 2020 were retrospectively enrolled. All patients were categorized into groups according to postoperative SIRS and urosepsis status. Single factor analysis and multivariate logistic regression analysis were performed to determine the predictive factors of SIRS and urosepsis after PCNL. The nomograms were generated using the predictors respectively and the discriminative ability of was assessed by analyses of receiver operating characteristic curves (ROC curves). Results: A total of 758 PCNL patients were enrolled in this study, including 97 (12.8%) patients with SIRS and 42 (5.5%) patients with urosepsis. Multivariate logistic regression analysis suggested that there were 5 factors related to SIRS, followed by preoperative neutrophil to lymphocyte ratio (NLR) (odds ratio, OR = 1.721, 95% confidence interval, CI [1.116-2.653], p = 0.014), S.T.O.N.E. score (OR = 1.902, 95% CI [1.473-2.457], p < 0.001), female gender (OR = 2.545, 95% CI [1.563-4.144], p < 0.001), diabetes history (OR = 1.987, 95% CI [1.051-3.755], p = 0.035), positive urine culture (OR = 3.184, 95% CI [1.697-5.974], p < 0.001). And there were four factors related to urosepsis, followed by preoperative NLR (OR = 1.604, 95% CI [1.135-2.266], p = 0.007), S.T.O.N.E. score (OR = 1.455, 95% CI [1.064-1.988], p = 0.019), female gender (OR = 2.08, 95% CI [1.063-4.07], p = 0.032), positive urine culture (OR = 2.827, 95% CI [1.266-6.313], p = 0.011). A nomogram prediction model was established to calculate the cumulative probability of SIRS and urosepsis after PCNL and displayed favorable fitting by Hosmer-Lemeshow test (p = 0.953, p = 0.872). The area under the ROC curve was 0.784 (SIRS) and 0.772 (urosepsis) respectively. Conclusion: Higher preoperative NLR, higher S.T.O.N.E. score, female gender, and positive urine culture are the most significant predictors of SIRS and urosepsis. Diabetes history is the predictor of SIRS. These data will help identify high-risk individuals and facilitate early detection of SIRS and urosepsis post-PCNL.

Project description:Background:Postoperative sepsis is a lethal complication for percutaneous nephrolithotomy (PCNL). An early predictive model combined local and systemic conditions is urgently needed to predict infectious events. We aim to determine the preoperative predictors of sepsis after PCNL in patients with unilateral, solitary, and proximal ureteral stones. Methods:A total of 745 patients who underwent PCNL between January 2012 and December 2018 were retrospectively enrolled. Sepsis was defined based on the International Sepsis Definitions in 2001, and the preoperative factors were compared between the non-sepsis and sepsis groups. Univariable analysis and multivariable logistic regression analysis were conducted to determine the predictors for sepsis after PCNL. A nomogram was generated using the predictors. Results:In this study, 35 patients (4.7%) developed sepsis after PCNL. Univariate analysis showed that post-PCNL sepsis was associated with the female, lower albumin, higher globulin, lower albumin globulin ratio (AGR < 1.5), preoperative fever, leukocytosis (WBC ? 10,000 cells/?L), positive urine culture, leukocyturia (?50 cells/?L) and positive urine nitrite. Multivariate logistic regression analysis suggested that AGR < 1.5 (odds ratio [OR] = 5.068, 95% confidence interval [CI] [1.135-22.624], P = 0.033), positive urine culture (OR = 3.243, 95% CI [1.162-9.047], P = 0.025), leukocytosis (OR = 3.706, 95% CI [1.444-9.512], P = 0.006) and female (OR = 2.529, 95% CI [1.127-5.672], P = 0.024) were independent risk factors for sepsis. A nomogram was generated and displayed favorable fitting (Hosmer-Lemeshow test P = 0.797), discrimination (area under receiver operating characteristic curve was 0.807), and clinical usefulness by decision curve analysis. Conclusions:Patients with certain preoperative characteristics, such as female, lower AGR, positive urine culture, and leukocytosis, who undergo PCNL may have a higher risk of developing sepsis. A cautious preoperative evaluation and optimized treatment strategy should be considered in these patients to minimize infectious complications.

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Predictive factors for fever and sepsis following percutaneous nephrolithotomy: A review of 580 patients.

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