The Value Of IL-6、PCT Combined With Attention Value Of CT In Predicting Upper Urinary Tract Calculi With Pyonephrosis And Analysis Risk Factors

Objective: To explore the value of interleukin-6 and procalcitonin combined with attention value of CT in the early diagnosis of upper urinary tract calculi complicated with pyonephrosis and analysis of the risk factors.Finally,the guidance is provided for the early diagnosis,prevention and treatment of upper urinary tract calculi complicated with pyonephrosis.Methods : From September 2021 to September 2022,186 patients with upper urinary tract calculi complicated by hydronephrosis who were treated by our hospital were selected.Among them,45 cases were with pyonephrosis and included into case group,and 141 patients without pyonephrosis selected as the control group.All patients’ clinical data were recorded.General data: age,gender,body mass index and whether there was a history of hypertension,diabetes,fever,and surgery on the affected side.Laboratory test results: interleukin-6,procalcitonin,red blood cell count,hemoglobin count,white blood cell count,neutrophil count,lymphocyte count,serum albumin quantification,serum creatinine value,midstream urine culture results.Stone-related conditions: stone side,number of stones,stone size,stone location,and staghorn renal stone.Affected kidney condition: degree of hydronephrosis(mild,moderate,severe)and CT value of renal pelvis effusion.Univariate analysis was performed using SPSS26.0 to preliminarily screen indicators with statistical differences,and then binary logistic regression analysis was performed to screen independent risk factors for indicators with statistical differences.PCT,IL-6,effusion CT and combined receiver operating curve were drawn by Medcalc 19.0 to compare the predictive value of single factor and combination of two factors and combination of three factors for predicting upper urinary tract calculi with pyonephrosis.Results : A total of 186 patients with upper urinary tract calculi complicated with hydronephrosis were included,including 45 patients with pyonephrosis and 141 patients without pyonephrosis.Univariate analysis showed that there were significant differences between case group and control group in the presence or absence of history of diabetes,ipsilateral surgery,fever,PCT level,IL-6 level,stone diameter,number of stones,staghorn renal stone,degree of hydronephrosis,and CT value of renal pelvis effusion(p <0.05);further indicators with statistical differences were included in binary logistic regression for multivariate analysis,and the results showed that PCT level,IL-6 level,and CT value of renal pelvis effusion were independent risk factors of upper urinary tract calculi complicated with pyonephrosis.Finally,the ROC curve was drawn by Medcalc 19.0 and the curve characteristics were compared.The results showed that the area under the curve of PCT was the largest in univariate prediction,0.901,followed by IL-6 and effusion CT values,and the AUC was 0.875 and 0.861,respectively,indicating that the three independent risk factors had certain predictive value for pyonephrosis.However,the area under the curve of PCT combined with CT and IL-6 combined with CT value is0.974,and the combined prediction of the three indicators had the best diagnostic value for pyonephrosis,with an area under the curve of 0.993.After analyzing the area under the curve of single factor prediction and combined factor prediction,the results suggested that a single index of PCT,IL-6,CT value or combined multiple indexes had a predictive value on pyonephrosis,with significant statistical difference(P<0.001).The effects of pairwise prediction were compared and analyzed,These results show that the predictive effect of IL-6 combined with effusion CT value was apparently higher than that of IL-6 and effusion CT value alone,and the difference was statistically significant(P<0.05);the predictive value of PCT combined with effusion CT value was higher than that of IL-6 and effusion CT value alone,and the difference was statistically significant(P<0.05);The predictive effect of the combination of PCT,IL-6 and CT value of renal pelvis effusion was much higher than that of single index,and the difference was statistically significant(P<0.001);the results showed that the predictive efficiency of the combination of PCT,IL-6 and CT value of renal pelvis effusion was better than that of single index Conclusions:1.PCT,IL-6,and CT value levels of renal pelvis effusion were higher in the case group compared with the control group.2.PCT and IL-6 levels and CT value of renal pelvis effusion were correlated with upper urinary tract calculi with pyonephrosis,which were independent risk factors of pyonephrosis.3.PCT,IL-6 and CT value of renal pelvis effusion,PCT + CT value of renal pelvis effusion,IL-6 + CT value of renal pelvis effusion and PCT + IL-6 + CT value of renal pelvis effusion can predict upper urinary tract calculi with pyonephrosis.When PCT was greater than 3.89 ng/ml,the probability of pyonephrosis Larger;when IL-6 was greater than 7.32pg/ml,pyonephrosis was more likely;and when CT value of renal pelvis effusion was greater than 8.10 HU,pyonephrosis was more likely.The predictive value of PCT combined with CT value and IL-6 combined with effusion CT value was higher than that of IL-6 and CT value.The predictive value of the combination of the three is better than that of the single index.