| Objective: The clinical data of 430 patients with percutaneous nephrolithotomy(PCNL)in our hospital were retrospectively analyze,to explore the risk factors of PCNL-related urosepsis,and to develop a prediction model of PCNL-related urosepsis,and to provide certain clinical basis for the prevention of PCNL-related urosepsis.Methods: Clinical data of 430 patients admitted to the Department of Urology,the Second Affiliated Hospital of Hainan Medical University from August 2020 to December 2022 were collected.The risk factors of PCNL-related urosepsis were analyzed statistically,and the risk prediction model of PCNL-related urosepsis was developed according to the related risk factors,and the working characteristic curve of subjects was drawn.Results: A total of 430 patients with PCNL were collected,including 33 patients in the group of PCNL-related urosepsis,and the incidence rate was 7.7%,in which 1patient was dead,mortality of 0.23%.The results of urine culture in patients with urosepsis after PCNL surgery were mainly Gramnegative bacteria,especially Escherichia coli.The results of univariate logistic regression analysisshowed that there were statistical differences between the case group and the control group in gender,operation time,positive preoperative urine culture,urinary white blood cells,urinary nitrous acid,stone diameter and percutaneous puncture channel size(P<0.05).Multivariate Logistic regression analysis showed that preoperative urine culture positive results(OR=3.607,95%CI1.479～8.797,P=0.005),gender(OR=2.800,95%CI1.206～6.501,P=0.017),operation time(OR=3.283,95%CI1.434～7.518,P=0.005),urinary leukocyte 2+(OR=5.643,95%CI1.130～28.188,P=0.035),urinary leukocyte 3+(OR=6.864,95%CI1.471～32.037,P=0.014),stone diameter ≥2.5cm(OR=2.333,95%CI1.037～5.249,P=0.041)were independent risk factors for urosepsis after PCNL surgery(OR>1,P<0.05).The area under the curve(AUC)for female women,urinary leukocytes,positive urine culture,stone diameter ≥2.5cm,operation time≥90 min to predict postoperative urosepsis after PCNL was 0.641,0.736,0.711,0.632,and 0.649,respectively(P <0.05).According to the results of multivariate logistic regression analysis,an early prediction modelof risk factors for PCNL-related urosepsis was established,and the worker curve(ROC)was drawn according to the disease risk prediction model,and the Hosmer-Lemeshow goodness-of-fit test showed that χ2=3.516,P=0.898> 0.05,indicating that the model passed the test.The analysis results of the area under the curve of the prediction model by ROC curve show that the area under the curve(AUC)is 0.860(0.808～0.911),the threshold is0.051,the corresponding sensitivity is 90.9%,and the specificity is 69.8%,indicating that the predicted effect of the established model is better.Conclusions: 1.Female,operation time ≥90min,urine leukocytes 2+/3+,stone diameter ≥2.5cm,positive preoperative urine culture are risk factors for PCNL-Related urosepsis.2.The ROC curve is used to analyze the area,sensitivity and specificity of each independent risk factor,and an early prediction model is construct according to the results of multivariate regression analysis,and all evaluations of the model are good,which can better predict the occurrence of urosepsis in PCNL patients.3.A comprehensive understanding of the mechanism and high risk factors of urosepsis can reduce the incidence of PCNL patients with this disease.In addition,optimizing the technology and ability of diagnosis and treatment of this disease can improve the surgical safety of PCNL. |
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