Systemic inflammatory response syndrome after percutaneous nephrolithotomy: An assessment of risk factors

Chen, Liang; Xu, Qiong; Li, Jianxing; Xiong, Liu‐Lin; Wang, Xiaofeng; Huang, Xiaobo

doi:10.1111/j.1442-2042.2008.02170.x

Cited by 77 publications

(60 citation statements)

References 14 publications

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“…This holds true for PCNL also. Post PCNL SIRS is commonly reported in about 20-30% of patients and has the potential to progress to severe sepsis (0-3%), which has mortality rates of 50-60% [2,3,6,7]. Thus, minimising infection-related complications is priority to maintain low morbidity rates.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Objectives: To identify perioperative risk factors for postoperative systemic inflammatory response syndrome (SIRS) and suggest possible modifications to reduce morbidity. Material and Methods: We prospectively analysed perioperative data such as history of pervious stone surgery, number and configuration of stones, presence of stent or nephrostomy, any previous positive urine culture, intraoperative renal pelvic urine and stone culture, aspiration of turbid urine on initial puncture, number of tracts required and clearance of stones, operative time and intraoperative hypotension and tachycardia of all patients who underwent percutaneous nephrolithotomy over a period of 15 months. Results: A total of 182 patients were included, average stone size was 2.8 cm, 36.2% had staghorn stones and 15.9% had an indwelling stent or nephrostomy. Despite sterile preoperative urine culture, renal pelvic urine culture (RPUC) was positive in 14.8% (27 patients) and stone culture was positive in 21.9% (40 patients). SIRS developed in 17.5% (32 patients) and septic shock in 1.09% (2 patients). On analysis younger age, positive RPUC and stone culture, longer operative time and intraoperative tachycardia correlated significantly with the development of SIRS. Conclusion: Intra-operative cultures are only therapy-guiding cultures during SIRS, as preoperative urine cultures seldom accurately depict bacteriological status of upper tracts and thus should be obtained in all patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…The results of this study corroborate the hypothesis that probably a non-infectious mechanism is involved in the development of SIRS encountered after PCNL. In a previously reported study by Chen et al [11], the incidence of SIRS in 209 patients who underwent PCNL was reported as 23.4%. Number of tracts, blood transfusion, stone size and presence of pyelocaliectasis were identified as risk factors for the development of SIRS.…”

Section: Discussionmentioning

confidence: 93%

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

Eğilmez¹

2015

Ann Clin Anal Med

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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.

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“…Positive preoperative urine culture does not predict urosepsis and systemic inflammatory response syndrome in PCNL. 26,27 Although antibiotic prophylaxis can decrease infectious complications, 28 the use of renal pelvic urine and stone cultures, and treatment of preoperative UTI should not be forgotten especially in patients with renal anomalies, hydronephrosis, large or staghorn stones and multiple tracts. 26,27 One study reported no difference in the complication rates between groups with normal and impaired renal function.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 Although antibiotic prophylaxis can decrease infectious complications, 28 the use of renal pelvic urine and stone cultures, and treatment of preoperative UTI should not be forgotten especially in patients with renal anomalies, hydronephrosis, large or staghorn stones and multiple tracts. 26,27 One study reported no difference in the complication rates between groups with normal and impaired renal function. 29 However, another study reported that chronic kidney disease stages had significantly different complication rates and Clavien scores, and decreased kidney function came with an increase in complication rates.…”

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confidence: 99%

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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Cite as: Can Urol Assoc J 2015;9(1-2):e83-92. http://dx.doi.org/10.5489/cuaj.2248 Published online February 9, 2015. AbstractIntroduction: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). Methods: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stonerelated parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. Results: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. Interpretation: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC. IntroductionPresently, percutaneous nephrolithotomy (PCNL) is preferred as a safe and effective way to remove large or multiple upper urinary tract calculi. [1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.1,2,4,5 Following PCNL, 79.5% of patients may experience an uncomplicated postoperative period, 5,8 although there are reports of an early complication rate of 50.8%. 4PCNL complications may occur during puncturing, access, or stone removal. 4 A standardized classification allow us to compare complications among different instruments, te...

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Systemic inflammatory response syndrome after percutaneous nephrolithotomy: An assessment of risk factors

Cited by 77 publications

References 14 publications

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

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

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

Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

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