Role of inflammatory markers and their trends in predicting the outcome of medical expulsive therapy for distal ureteric calculus

Abstract

Objective: Symptomatic ureteric stones cause surrounding inflammation-promoting obstruction. C-reactive protein (CRP), white blood cell count (WC), and neutrophil percentage (NP) tend to rise after inflammatory response. Monitoring response during the course of medical expulsive therapy (MET) may help in deciding early intervention, thereby decreasing morbidity. We assessed the role and trends of these markers in predicting the outcome of MET. Materials and Methods: One hundred and ninety-two patients with distal ureteric calculus of size >5 mm were included in this prospective study from April 2017 to March 2018 after ethical committee approval. CRP, NP, and WC were measured on day 1, 7, and 14 of MET, and analysis was done. Results: On univariate analysis, stone size and mean values of CRP, WC, and NP on day 1, 7 and 14 in stone nonpassers were significantly higher compared to stone passers ( P < 0.05). Receiver operator curve analysis showed area under the curve value of 0.798 ( P = 0.001) for CRP and cut off value determined was 1.35 mg/dL. Multivariate analysis of different variables showed significant association of higher CRP (>1.35 mg/dL) and larger stone size (>7 mm) with MET failure. Decreasing trend of CRP was seen in both groups, but values were higher in stone nonpassers. WC and NP showed decreasing trend in stone passers but persistently high in stone nonpassers. Conclusions: Higher CRP and larger stone size were associated with failure of MET. WC and NP showed decreasing trend in stone passers and persistently higher in nonpassers, which may potentially predict failure of MET, however, their role need to be further studied.

Predictive Value of C-reactive Protein in the Spontaneous Passage of Lower Ureteric Stones: A Prospective Single-Centre Study

“…Across these studies, the majority of patients fell within the 20-45 age range. In multiple studies, age and sex did not show notable variances [27][28][29][30][31]. Furthermore, Ozcan et al [24] observed a higher rate of SSP in the younger age category, with no significant distinctions in sex between the groups, mirroring our findings.…”

Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic

“…In our study, neutrophil count only approached statistical significance (P = 0.06) in multivariable logistic regression but was observed to have a relevant impact on SSP through the modelling process. Previously Sfoungaristos et al [18] showed a significant association between neutrophilia and SSP which was not replicated in a more recent study [25]. Therefore, the exact predictive role of neutrophil count for SSP remains unclear.…”

“…Previously Sfoungaristos et al. [18] showed a significant association between neutrophilia and SSP which was not replicated in a more recent study [25]. Therefore, the exact predictive role of neutrophil count for SSP remains unclear.…”

The role of inflammatory serum markers and ureteral wall thickness on spontaneous passage of ureteral stone < 10 mm: A prospective cohort study

“…Based on the stone location, the SSP will change ranging from 79%, 60%, and 48% for distal, mid, and proximal ureteral stones respectively. The EAU/AUA panel studied SSP based on a meta-analysis that showed 68% for <5 mm stones and 48% for 5–10 mm stones [ 24 ]. The current study showed a 55.9% SSP rate, and the stone size was significantly smaller in comparison with non SSP patients (6.43 ± 1.60 versus 7.76 ± 1.49) with a p-value < 0.001, while the rate of SSP concerning the stone location was 25%, 37,5%, and 61.2% for the proximal, mid and lower ureteral stones respectively which is relatively lower than the previously mentioned studies.…”