Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy

Abstract

Purpose This study aims to identify clinical factors that may predispose struvite stone patients to urosepsis following percutaneous nephrolithotomy (PCNL). Materials and Methods A retrospective review was conducted on patients who received PCNL for struvite stones. The Systemic Inflammatory Response Syndrome (SIRS) criteria and quick-Sepsis Related Organ Failure Assessment (q-SOFA) criteria were used to identify patients who were at an increased risk for urosepsis. Statistical analysis was performed using Fisher's exactness test, Wilcoxon rank test, and logistic regression. Results Chart review identified 99 struvite stone patients treated with PCNL. Post-operatively, 40 patients were SIRS positive (≥2 criteria) and/or q-SOFA positive (score ≥2). Using SIRS as an approximation for urosepsis, longer operative times (p<0.001), higher pre-operative white blood cell counts (p=0.01), greater total stone surface area (p<0.0001), and pre-operative stenting (OR, 5.75; p=0.01) were identified as independent risk factors for urosepsis. Multivariate analysis demonstrated pre-operative stenting (OR, 1.46; p=0.01) to be a risk factor. With q-SOFA, univariable analysis found that antibiotic use within 3 months prior to a PCNL (OR, 4.44; p=0.04), medical comorbidities (OR, 4.80; p=0.02), longer operative times (p<0.001), lengthier post-operative hospitalization (p<0.01), and greater total stone surface area (p<0.0001) were risk factors for urosepsis. Multivariate analysis revealed that bladder outlet obstruction (OR, 2.74; p<0.003) and pre-operative stenting (OR, 1.27; p=0.01) significantly increased odds of being q-SOFA positive. Conclusions Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.

Risk factors for urosepsis in chronic kidney disease patients with urinary tract infections

“…Consistent with the study of Chan et al 37 , duration of hospitalization was also identified as an independent risk factor for urosepsis among our patients' population. Prolonged hospitalizations are associated with a risk of infection, especially in those with multiple comorbidities 38 .…”

Nomogram for predicting risk factor of urosepsis in patients with diabetes after percutaneous nephrolithotomy

“…Therefore, through the early identification of the factors associated with urosepsis, it is significant to avoid serious postoperative complications. In our study, the incidence rate of postoperative urosepsis was 19.4%, which was higher than that reported in a previous study [ 5 ]. This may be related to all patients with diabetes enrolled in this study.…”

“…Many studies have demonstrated the risk factors for urosepsis after PCNL [ 4 , 5 ], including staghorn calculi, positive midstream urine culture, preoperative stenting, and bladder outlet obstruction. However, at present, most studies ignore an important factor, namely intraoperative blood pressure, combined with intraoperative anesthetic blood pressure.…”

Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

“…A recent study identified some predictors of urosepsis after PCNL treatment for struvite stones: higher preoperative white blood cell count, greater total stone surface area, preoperative stenting, recent use of antibiotics, and obstructive uropathy [ 43 ]. In another study, sepsis was approximately four times more common in patients with struvite stones treated with PCNL.…”