Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy

Justin Y.H. Chan; Victor K.F. Wong; Julie Wong; Ryan F. Paterson; Dirk Lange; Ben H. Chew; Kymora B. Scotland

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자료유형: 학술저널

저자정보: Justin Y.H. Chan (University of British Columbia) Victor K.F. Wong (University of British Columbia) Julie Wong (University of British Columbia) Ryan F. Paterson (University of British Columbia) Dirk Lange (University of British Columbia) Ben H. Chew (University of British Columbia) Kymora B. Scotland (University of California)

저널정보: 대한비뇨기과학회 Investigative and Clinical Urology Investigative and Clinical Urology Vol.62 No.2

발행연도: 2021.1

수록면: 201 - 209 (9page)

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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.

#Nephrolithotomy #percutaneous #Quick-sepsis related organ failure assessment #Struvite #Systemic Inflammatory Response Syndrome #Urosepsis

참고문헌 (30)

참고문헌 신청

Flannigan R / 2014 / Renal struvite stones--pathogenesis, microbiology, and management strategies / Nat Rev Urol 11:333~341

Rivera M / 2016 / Pre-and postoperative predictors of infection-related complications in patients undergoing percutaneous nephrolithotomy / J Endourol 30:982~986

Michel MS / 2007 / Complications in percutaneous nephrolithotomy / Eur Urol 51:899~906

Scotland KB / 2018 / Prevention and management of urosepsis triggered by ureteroscopy / Res Rep Urol 10:43~49

Dreger NM / 2015 / Urosepsis--etiology, diagnosis, and treatment / Dtsch Arztebl Int 112:837~847

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