Fever and Systemic Inflammatory Response Syndrome Seen After Percutaneous Nephrolithotomy: Review of 1290 Adult Patients

Abstract

ASA skoru ≥3, ameliyat süresi >120 dk., ΔHb >2 gr/dL, taş boyutu ve Clavian 5 komplikasyonlar ile SIRS gelişimi arasında istatistiksel anlamlı korelasyon bulunmaktadır. 181 (%14) hastada görülen , ateş epizodunun ölüme götüren SIRS'a ilerleme insidansı %1,6 olarak tespit edilmiştir. Tartışma: Postoperatif ateşin hayatı tehdit eden bir duruma ilerleme riski düşüktür. Fakat kan kaybı 2 gr/dL'den fazla ve/veya ameliyat süresi 120 dakikadan fazla olması gibi diğer SIRS kriterlerine sahip hastalara özel önem verilmelidir. Çok az hastada görülmesine rağmen çoklu organ yetmezliği ile ölüme neden olabilmektedir. Anahtar KelimelerPerkütan Nefrolitotomi; Sistemik Yangısal Yanıt Sendromu; Ateş Abstract Aim: Although accepted as minimally invasive, percutaneous nephrolithotomy (PCNL) still poses a significant risk of complications. Recent studies suggest that the incidence of sepsis may be higher than previously reported. The systemic inflammatory response syndrome (SIRS) seen in the subset of patients with or without bacteremia, is a life threatening complication and the purpose of this study is to give an insight to the relation between a post-operative fever episode and the risk of developing SIRS. Material and Method: Medical files of 1646 adult patients to whom a PCNL operation was performed were reviewed. A total of 1290 patients fulfilled the needed criteria and were included in the study. Study variables were recorded from the medical files for statistical analysis. Results: Stone burden had a statistically significant correlation with SIRS (p<0.05) but not with fever. Comorbidities of the patients alone did not have a correlation with fever or SIRS. But ASA score 3 and 4 showed statistically significant correlations with SIRS (p<0.05). Majority of the 288 complications encountered were Clavian grade 2 and grade ≥2 complications were seen to increase the hospitalization period (p<0.05). Operation time >120 min. was the only operative variable that had correlation with both fever and SIRS (p<0.05). Blood loss >2 g/dl (Δhaemoglobin-Hb) and Clavian 5 complications had statistically significant correlations with fever. ASA score ≥ 3, operation time >120 min., ΔHb >2 gr/ dl, stone size and Clavian 5 complications had statistically significant correlations with the development of SIRS. The incidence of a fever episode, which was seen in 181 patients (14%), to progress to SIRS, which leaded to death, was found to be 1.6%. Discussion: Postoperative fever has a low risk of progressing to a life threatening condition. But special attention should be given to patients that also have the other SIRS criteria; blood loss more than 2 g/dl and/or operation time more than 120 minutes. Although only encountered in a small subset of patients, multiple organ dysfunctions can develop leading to death.

Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes

“…Postoperative fever (not always related to infections) is one of the most common complications after PCNL and can affect upto 30% of patients. Rates of systemic inflammatory response syndrome (SIRS) can be as high as 23.4-29% and rates of sepsis range from 0 to 3% (higher in recent studies) [1,2,3]. SIRS, which includes fever, tachycardia, tachypnea and leucocytosis, is poorly understood non-infectious inflammatory response of the body to stress and has the potential to progress to multiple organ failure.…”

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

“…Urosepsis is infrequent but a dreaded complication with an incidence ranging from 0.25% to 4.7% in various series. [ 2 3 ] Urosepsis can progress to multiorgan dysfunction syndrome (MODS), which has a high mortality. Therefore, predicting and preventing factors leading to urosepsis become of utmost importance.…”