Analysis Of Preoperative Indexes Of Systemic Inflammatory Response Syndrome After Ureteroscopy Combined With Holmium Laser Lithotripsy

Objective:To analyze the preoperative clinical data of postoperative systemic inflammatory response syndrome in adult patients with urinary lithiasis treated by ureteroscopy combined with holmium laser,and to explore the relevant risk indicators,in order to provide reference for preventing the occurrence of SIRS after clinical URSLL.Methods:Patients with urinary calculi in the sixth affiliated Hospital of kunming Medical University from January 2018 to December 2020 were treated with holmium laser lithotripsy under ureteroscope.A total of 329 patients were selected according to the exclusion criteria and inclusion criteria.According to the occurrence of SIRS after operation,the patients were divided into SIRS group and non-SIRS group,and analyzed retrospectively.The relationship between postoperative SIRS and basic or clinical characteristic age,sex,body mass index,hypertension,diabetes,location and size of stone,preoperative peripheral blood leukocytes,preoperative neutrophil,preoperative leukocyte,preoperative monocyte,preoperative platelet,preoperative creatinine,preoperative urinary leukocyte,neutrophil-lymphocyte ratio(NLR),lymphocyte-monocyte ratio(LMR),platelet-lymphocyte ratio(PLR),operation time and ASA grade were statistically analyzed.(P<0.05 is considered to be statistically significant).First of all,the selected indicators are analyzed by univariate analysis,then the significant indexes in the univariate analysis were analyzed by the likelihood ratio test based on the maximum partial likelihood estimation in the Logistics multifactor regression analysis,and the ROC joint curve was drawn according to the results.Results:Of the 329 selected patients,72(21.88%)developed SIRS.Single factor analysis:Age(P=0.013),hypertension(P=0.005),preoperative creatinine(P=0.001),preoperative peripheral blood leukocytes(P=0.008),preoperative neutrophil(P=0.007),NLR(P=0.021),PLR(P=0.041),preoperative urinary leukocyte(P=0.027)and operation time(P=0.001)were associated with postoperative SIRS.Sex(P=0.93),BMI(P=0.47),diabetes(P=0.259),stone location(P=0.451),stone size(P=0.697),ASA grade(P=0.944),preoperative lymphocyte(P=0.314),preoperative monocyte(P=0.218),preoperative platelet(P=0.829)and LMR(P=0.149)were not related to SIRS after URSLL.Multivariate analysis showed that age(P=0.015,OR=1.027),preoperative neutrophil(P=0.011,OR=1.265),reoperative creatinine(P=0.030,OR=2.033),preoperative urinary leukocyte(P=0.043,OR=2.180)and operation time(P=0.002,OR=1.021)were independent predictors of SIRS after ureteroscopy combined with holmium laser lithotripsy.ROC curve showed that the combination of preoperative neutrophils,operation time,age,preoperative urinary leukocyte and preoperative creatinine had certain predictive value(AUC=0.719,95%CI:0.650-0.788).Conclusion(s):Age,hypertension,preoperative peripheral blood leukocytes,preoperative neutrophil,preoperative creatinine,NLR,PLR,preoperative urinary leukocytes and operation time are risk indicators for the development of systemic inflammatory response syndrome after ureteroscopy combined with holmium laser lithotripsy.Age,preoperative neutrophil,preoperative creatinine,preoperative urinary leukocytes and operation time are independent predictors of SIRS after ureteroscopy combined with holmium laser lithotripsy.In the predictive model,the predictive efficiency of five indexes(age,preoperative neutrophils,preoperative creatinine,preoperative urinary leukocytes and operation time)combined with ROC curve(AUC=0.719,95%CI:0.650-0.788)was better than that of single index.