Risk factors for systemic inflammatory response syndrome after percutaneous nephrolithotomy

Abstract

Objectives: To explore the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL).

Methods: A retrospective chart review was performed to identify 1030 patients who had undergone PCNL from January 2014 to July 2016 in the Minimally Invasive Surgery Center. Multiple data, including age, sex, body mass index (BMI), operation time, Staghorn calculi, diabetes, Serun creatinine, preoperative urine culture and the urinary sediment microscopy white blood cell (WBC) were collected. These factors and postoperative SIRS were retrospectively analyzed.

Results: There were 108 cases (10.49%) of SIRS among 1030 patients. The results of univariate analysis showed that sex (P=0.015), Staghorn calculi (P<0.001), preoperative urinary culture of Gram-negative bacteria (P<0.001) and preoperative urinary sediment microscopy WBC (+, ++, +++, ++++) (P<0.001, P<0.001, P=0.009, P=0.045) were correlated with postoperative SIRS (P<0.05). According to Multivariate analysis results, the likelihood of SIRS after PCNL increased with Staghorn calculi (P=0.01, OR=10.457, 95% CI=1.312-3.092), the urinary sediment microscopy WBC (+∼++++) (P<0.001, OR=2.591, 95% CI=1.661-4.042) and positive urine culture for Gram-negative bacteria (P<0.001, OR=3.550, 95% CI=2.205-5.715).

Conclusions: Staghorn calculi, the urinary sediment microscopy WBC and positive urine culture for Gram-negative bacteria are independent risk factors for SIRS. Patients affected by these risk factors should receive careful anti-infectious perioperative management for prevention of postoperative SIRS.

Level of incidence: 4.

Keywords: Facteur de risque; Microscopie préopératoire des sédiments urinaires; PCNL; Preoperative urinary sediment microscopy; Risk factor; SIRS; WBC.