Influencing Factors Of Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy And Establishment Of Prediction Models

Background: Urinary tract stones are common diseases in urology,a nd most of them are upper urinary tract stones.With the continuous devel opment of minimally invasive facilities and lithotripsy methods,percutan eous nephrolithotomy(PCNL)is currently the main treatment method for upper urinary tract stones.According to studies,the incidence of sepsis a nd septic shock after PCNL is as high as 0.3-9.3%,which is 20 times the incidence of septic shock after other intracavi tary surgery.Early diagnosis of septic shock after PCNL and intervention in its occurrence can reduce the risk of increased mortality and prolonged hospital stay.Systemic inflammatory response syndrome(SIRS)is the m ost common manifestation feature after PCNL,and it has a higher probabi lity of progressing to fatal sepsis.Therefore,in terms of predicting the oc currence of SIRS after PCNL,it has important clinical value,and it also p roves that the application of its early diagnosis and prediction tools is ver y important.Objective: To analyze the relevant independent factors influencing th e occurrence of SIRS after PCNL,and to establish a logistic stepwise regr ession prediction model for SIRS after PCNL,and to perform model verif ication and data visualization.Method: A retrospective analysis of the clinical data and related data of 229 patients diagnosed with upper urinary tract stones in the Urology Department of the First Affiliated Hospital of the University of South Chi na from January 2019 to December 2019 was retrospectively analyzed.A ll patients underwent PCNL in our department.Among them,140 were m ales and 89 were females.The perioperative clinical indicators such as ag e,body mass index(BMI),preoperative urinary white blood cells,and hy pertension history were collected before operation.The relationship betw een perioperative indicators and SIRS after PCNL was analyzed by single factor and multivariate Logistic regression,and independent risk factors were screened out,and a logistic regression predictive model of SIRS was established based on this.The OR value was calculated and the forest plo t was constructed,and the data was simultaneously visualized.HosmerLemeshow test and calibration curve are used to test the goodness of fit o f the prediction model,evaluate its discriminative ability and prediction a ccuracy,and evaluate the effectiveness of the prediction model through th e area under the ROC curve.Result: Among the 229 patients who underwent PCNL surgery in thi s study,50 cases of SIRS occurred after surgery,with an incidence rate of21.8%.Single factor Logistic regression analysis showed that the maxim um diameter of stones,operation time,multiple stones(yes),preoperative urinary white blood cells(++/+++),stone location factors and the occurr ence of SIRS after PCNL have a certain relationship(P<0.05).Multivaria te logistic regression analysis showed that operation time and preoperativ e urinary white blood cell(++/+++)factors were independent risk factors for SIRS after PCNL.Stepwise regression prediction model: Logit(P)=0.0415748+1.0205754operation time+2.6263544preoperative urine whit e blood cells(++/+++).The ROC curve is 0.7189,95%CI(0.6444-0.7934).Hosmerlemeshow Tests showed that the model was established,and predictive eff iciency is better(P> 0.05).Conclusion: The results of this study showed that the operation time,preoperative urine white blood cells(++ / +++)factors were independent influencing factors of SIRS after PCNL,and the predictive model establi shed by these independent influencing factors had a certain value for risk prediction and evaluation.Clinically,it can reduce the occurrence of adve rse consequences such as postoperative SIRS by improving intraoperative efficiency,reducing the operation time,and reducing preoperative urine white blood cells.