Risk factors for fever and sepsis after percutaneous nephrolithotomy

Rashid, Aso Omer; Fakhulddin, Saman Salih

doi:10.1016/j.ajur.2016.03.001

Cited by 41 publications

(33 citation statements)

References 21 publications

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“…PCNL surgery brings about a stress response and backflow of pathogens and toxins, which accelerates the spread of infection and further leads to the occurrence of sepsis. Unlike other studies that only focus on local factors 20,21 , our study found that AGR, a systemic factor, maybe one of the important predictive factors of sepsis after PCNL. Another systemic factor noted in our study to be closely related to sepsis after PCNL is preoperative leukocytosis (RR=3.706, P =0.006).…”

Section: Discussioncontrasting

confidence: 87%

Peer Review #1 of "A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones (v0.1)"

Rashid¹

2020

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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/μL), positive urine culture, leukocyturia (≥50 cells/μL) 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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Section: Discussioncontrasting

confidence: 87%

Peer Review #1 of "A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones (v0.1)"

Rashid¹

2020

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“…Similar results were seen in other studies 1,8,[10][11] while in the study in the Department of Urology of Mayo Clinic, it was observed in only 9% of patients. 5 Sepsis was seen in 6.2 % of patients which was similar to other results 4,[11][12] while Mayo clinic study showed low sepsis rates which was as low as 0.9 % . 5…”

Section: Discussionsupporting

confidence: 83%

“…11 Another study from Iraq showed positive association of sepsis with number of stones, duration of operation time, total leukocyte count, hemoglobin level and residual stone. 4…”

Section: Discussionmentioning

confidence: 99%

Prediction of Infectious Complications after Percutaneous Nephrolithotomy

Chhetri

Baral

Thapa

2018

J. Soc. Surg. Nepal

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Introduction: Post-operative infection is one of the most common and potentially life-threatening complications following percutaneous nephrolithotomy, ranging from Systemic inflammatory response syndrome (SIRS) to severe sepsis. It is reported to be the most common peri-operative cause of death. Despite taking utmost precautions, we come across major complications such as haemorrhage and urosepsis after percutaneous nephrolithotomy. This study aims to find the risk factors for infectious complications after percutaneous nephrolithotomy. Methods: This was an observational, cross-sectional, analytical study carried out in the Department of Surgery of Lumbini Medical College and Teaching Hospital over a period of six months. Pre- operative and intra-operative parameters of ninety-seven patients who underwent percutaneous nephrolithotomy were analysed to see the association between perioperative and intraoperative factors in development of post-operative infectious complications. Results: Post-operatively, SIRS was observed in 28.9% of the patients and 6.2% developed post operative sepsis. Stone burden, types of stone, abnormal urinalysis and mean operative time were associated with post-operative SIRS while stone burden, abnormal urinalysis, positive urine culture and operation time were statistically associated with post-operative sepsis. In univariate analysis only mean operation time and mean stone burden were statistically associated in development of post operative SIRS and sepsis. Conclusion: In the present study mean operation time and mean stone burden were found to be the predictive factors for post-operative infectious complications after percutaneous nephrolithotomy.

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“…Less aggressive strategies would avoid risky interventions and increase the possibility of repeated treatment. Multiple punctures, supracostal access and a longer surgical duration may be needed for complex stones, but these risk factors significantly increase the complication rates of bleeding, fever, and renal function impairment . Other studies reported initial and final SFRs of 35.7–52.1% and 71.7–88.3%, respectively, after PCNL in patients with a SK , which means a balance between higher SFRs and lower complication rates can be attained in large experienced centres.…”

Section: Discussionmentioning

confidence: 99%