Predicting and comparing postoperative infections in different stratification following PCNL based on nomograms

Abstract

To discuss the mechanisms of infection complications in different degrees after percutaneous nephrolithotomy (pcnL) through predicting and comparing post-pcnL infections based on nomograms, a retrospective cohort study was conducted among 969 cases who underwent PCNL from Dec 5, 2016 to Dec 25, 2017 in Kunming, Yunnan Province. We examined clinical features, urine routine, blood routine, blood biochemistry, imaging studies and operative information and recorded the examination results before surgery for univariate and multivariate logistic regression. We applied receiver operating characteristic curves, calibration curves, accuracy, specificity, sensitivity, positive predictive value and negative predictive value to evaluate and compare the models. Nomograms were used to visualize the different degrees of postoperative infection complications. The risk scores of the three groups were compared by diabetes mellitus distribution. Our results suggest that the more severe the infection is, the more accurate the model predicts and that the occurrence of severe infection mostly is related to the patients' homeostasis. Hence, we developed an online post-PCNL sepsis dynamic nomogram which can achieve visualization and dynamically predict the incidence of sepsis in postoperative patients. Kidney stones, one of the most common urologic diseases, show an upward trend annually 1 , especially in Southwest China where the incidence rate is higher than those in other parts of the country 2. PCNL is used as the standard method in the treatment of upper urinary tract stone > 2 cm 3 with minimal invasion and a faster and higher stone clearance rate 4. However, complications are reported including fever (21.0-32.1%), blood transfusion (11.2-17.5%), extravasation (7.2%) and septicemia (0.3-4.7%) 5. Infection, as a major complication, is graded into fever, systemic inflammatory response syndrome (SIRS), and sepsis according to the severity. Previous studies have reported the risk factors on the severity of infectious complications, such as gender, nephrostomy 6 , preoperative positive urine culture 7 , stone size 8 , age, diabetes mellitus and complex stones 9. Risk factors of SIRS include PCNL operation history, stone size, degree of hydronephrosis, complex stones, preoperative positive urine culture, perfusion pressure, and neurogenic bladder and the use of antibiotics 10-13. Risk factors of sepsis include stone burden, infectious stone, the number of tracts, preoperative positive urine culture, leukopenia, creatinine and operation time 14-17. Nonetheless, most studies only discussed one or two infection outcomes and did not compare similarities and differences of infection concurrency between different degrees in the same samples. In this study, we established models to predict and to study the infection complications of different degrees after PCNL, and compared the differences between the models to illustrate the different infection mechanisms and the clinical significance. Finally, we developed online application to achieve visu...

Construction of an alignment diagram model for predicting calculous obstructive pyonephrosis before PNL

“…A study by Erdogan et al reached similar conclusions [ 15 , 16 ]. Many studies have focused on finding risk factors for complications of SIRS and sepsis after PNL [ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ], including female sex, diabetes mellitus, volume of renal stones, degree of hydronephrosis, density of hydronephrosis, urinary leukocytes, positive urine cultures and elevated blood neutrophils. There is still no precise stratified scoring system or comprehensive model to predict preoperative calculous obstructive pyonephrosis before PNL.…”

A Novel Nomogram for Predicting Post-Operative Sepsis for Patients With Solitary, Unilateral and Proximal Ureteral Stones After Treatment Using Percutaneous Nephrolithotomy or Flexible Ureteroscopy

“…Gao et al have found that preoperative Cr level and positive pre-operative multidrug-resistant (MDR) urine culture were independent risk factors in patients with struvite stones following PNL (18). Jiang et al have identified positive urine culture, serum calcium, and urine pH that were significantly connected with the incidence of sepsis after PNL (19). Moreover, Ozgor and his colleagues demonstrated that patients with ≤40 years old, operation time ≥60 min, and presence of renal abnormality were remarkably associated with infectious events following fURS (16).…”

Stone-scoring systems for predicting complications in percutaneous nephrolithotomy: A systematic review of the literature

“…nephrolithometry score; SFR S.T.O.N.E. Yes Graphic chart Smith et al [ 10 ] CROES score; SFR Stone burden, stone location, number of stones, and surgical volume Yes Graphic chart Jeong et al [ 11 ] S-ReSC; SFR Pelvi-caliceal system subdivided in nine separate locations, each location corresponding to 1 point Total score: cumulative sum of involved locations Yes Computed tomography imaging Xun et al [ 24 ] Urosepsis in general population Albumin-globulin ratio, leukocytosis, positive urine culture, and female sex No Graphic chart Jiang et al [ 25 ] Post-operative fever, SIRS, sepsis in general population Post-operative fever: leukocyturia and urine nitrite SIRS: positive urine culture, positive urine nitrite, and operation time Sepsis: positive urine nitrites, urine pH, positive urine culture, serum calcium, and operation time No Computer software and graphic chart Wang et al [ 26 ] Urosepsis in general population Presence of staghorn stone, pre-operative urine culture, and pre-operative nephrostomy No Graphic chart Gu et al [ 28 ] Urosepsis in general population Presence of urine nitrite, positive urine culture, intra-operative hypotension, and staghorn stone No Graphic chart Liu et al [ 27 ] Urosepsis in general population White blood cell count, presence of urine nitrites, positive urine culture, staghorn stone, and complete stone clearance No Graphic chart Zeng et al [ 29 ] Venous thromboembolism …”