Are Inflammatory Markers Useful in Predicting Urinary Tract Infection After Transrectal Ultrasound-Guided Biopsy of the Prostate?

Abstract

Background: Sepsis is a serious and life-threatening complication after transrectal ultrasound (TRUS)-guided prostate biopsy. It is critical to predict its occurrence prior to conducting the biopsy. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte (PLR) have been proven to be promising diagnostic indicators of infectious complications after various surgical procedures. The aim of this study was to determine whether inflammatory markers, NLR and PLR ratios, are useful surrogates to predict sepsis after TRUS biopsy. Methods: A total of 378 patients underwent TRUS-guided prostate biopsy with no clinical evidence of prostatitis from December 2009 to May 2013 in American University of Beirut Medical Center. Data collected included age, smoking status, prostate size, post-void residual, prostate-specific antigen (PSA) value, blood culture, urine culture, Gleason score, pathology results, neutrophils, leukocyte count and platelet counts. Also, NLR and PLR were calculated. The primary outcome collected was sepsis. All data were entered and analyzed by Statistical Package for Social Sciences. Results: Of the 378 patients who underwent TRUS biopsy, 31 patients developed sepsis. Septic patients were younger (63.7 ± 6.2 years) than non-septic patients (65.5 ± 8.0 years). No association between sepsis and NLR or PLR was observed; however, a significant association between sepsis and pre-biopsy urine analysis and pre-biopsy PSA (P = 0.011) was noted. Conclusion: In this study, none of the pre-procedure NLR and PLR studied was found to predict sepsis after TRUS biopsy. Future efforts should be directed to investigate this relationship in prospective studies.

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio, Novel Biomarkers and Applications in Urology: An Update

“…Heidar et al reviewed the total number of 378 patients who underwent in case of TRUS biopsy, among them 31 developed sepsis. They did not find the links between the pre-biopsy NLR or PLR and the development of sepsis post-biopsy, moreover the statistically remarkable correlation between the sepsis and pre-biopsy urine analysis as well as prostate-specific antigen level (PSA) [18]. Kazimoglu et al reported a significant decrease of NLR after renal transplantation and an important variation in the NLR was noted in between the Escherichia coli (E. coli) infected and uninfected recipients [19].…”