Analysis Of Risk Factors For Urinary Sepsis In Patients With Upper Urinary Tract Stones

BACKGROUND:Urinary stones are a common disease in urology,which can cause complications such as urinary sepsis and septic shock.Stone related urinary sepsis may also be caused by stone related urinary tract obstruction and intraluminal stone surgery.The clinical manifestations of urinary sepsis mainly include systemic inflammatory response,organ dysfunction,persistent hypotension,and tissue hypoxia induced chills,chills,shortness of breath,and lack of consciousness.In clinical practice,patients with urinary sepsis caused by upper urinary tract stones are not uncommon.They have a rapid onset,rapid progression,and a dangerous condition,which can easily progress to severe sepsis,septic shock,and even multiple organ failure.The mortality rate is as high as 30%-40%.The pathogenesis of urinary sepsis is complex and unclear,which is the result of the interaction between oxidative stress,inflammatory response,immune response,coagulation response,and other factors.Most patients may not have obvious signs in the early stage,and the diagnostic criteria for sepsis are complex.Therefore,it is easy to encounter difficulties in early identification and diagnosis,and even misdiagnosis and missed diagnosis in clinical practice.The diagnosis and treatment guidelines for sepsis emphasize that early diagnosis and intervention play a crucial role in improving the prognosis of sepsis patients.At present,the gold standard for the diagnosis of urinary sepsis is still blood and urine bacterial culture.However,pathogenic testing in clinical practice takes a long time and has a low positive rate.There is an urgent need for simple,specific,and sensitive clinical indicators to provide evidence support for the early diagnosis of sepsis.Studying the risk factors of urinary sepsis associated with stones can be used for early diagnosis,early assessment of the severity of the condition,prompt and effective treatment,improvement of patient prognosis,and significant reduction of mortality.At present,research on the risk factors of urinary sepsis related to stones at home and abroad mainly focuses on postoperative stone surgery,while there is relatively little research on the risk factors of urinary sepsis in patients with urinary stones before or at admission.At present,there is an increasing trend in the number of patients with upper urinary tract stones combined with urogenic sepsis before or upon admission.Analyzing the relevant risk factors has certain clinical reference significance for early identification,screening,early warning,prevention,and treatment.OBJECTIVE:By analyzing the relevant risk factors of urinary sepsis in patients with upper urinary tract stones before or upon admission,an early warning model is constructed to provide clinical reference evidence for early and rapid identification and screening of high-risk patients with upper urinary tract stones who develop into urinary sepsis.METHODS:A retrospective analysis was conducted on the clinical data of upper urinary tract stone patients admitted to the Department of Urology at Huaihe Hospital of Henan University from January 2017 to January 2022.817 study subjects were selected based on inclusion and exclusion criteria.They were divided into a urine sepsis group(case group)of 30 cases and a non urine sepsis group(control group)of787 cases based on whether sepsis occurred before or at admission.The age,sex,height,weight,body mass index(BMI),history of diabetes,hypertension,previous stone surgery,stone location,maximum transverse diameter,affected side,CT values,whether there is staghorn stone,degree of hydronephrosis,CT values of hydronephrosis,white blood cell count,platelet count,C-reactive protein(CRP),procalcitonin(PCT),Urinary white blood cells,urinary nitrite,and urine culture related indicators were analyzed using chi square test and logistic regression analysis to identify independent risk factors for upper urinary tract stone patients with urinary sepsis.Establish an early warning model for patients with upper urinary tract stones complicated with urinary sepsis,and draw a receiver operating characteristic curve(ROC curve).RESULTS:1.There are 30 patients with upper urinary tract stones combined with urinary sepsis,with an incidence rate of 3.6%.Urinary culture results are mainly Gram negative bacteria,mainly Escherichia coli.2.Univariate analysis of all indicators included in this study,including age,gender,BMI,diabetes history,previous stone surgery history,maximum transverse diameter of stones,staghorn stones,degree of hydronephrosis,CT value of hydronephrosis,platelet count,CRP,PCT,urinary white cells,urinary nitrite,urine culture and other factors,there were statistical differences between the case group and the control group(P<0.05).3.Multivariate logistic regression analysis was conducted on factors with statistically significant differences in univariate analysis.The results showed age(≥65 years old)(P=0.041,OR=3.117,95%CI:1.141-8.521),gender(female)(P=0.007,OR=4.129,95%CI:1.361-12.401),previous history of stone surgery(P=0.026,OR=5.857,95%CI:2.681-13.524),maximum transverse diameter of stones(≥10mm)(P=0.036,OR=10.073,95%CI:1.095-92.732)CT value of hydronephrosis(>10Hu)(P=0.015,OR=19.428,95%CI:4.254-88.758),platelet count(<150×10~9/L)(P=0.002,OR=1.018,95%CI:1.043-1.131),blood C-reactive protein(≥50mg/L)(P=0.027,OR=63.558,95%CI:9.420-428.821),blood Calcitonin(≥10ug/L)(P=0.031,OR=9.016,95%CI:2.089-38.904),and urine nitrite(positive)(P=0.004,OR=3.212,95%CI:1.197-8.609)were positively related to the occurrence of upper urinary tract stones with urinary sepsis,which were independent risk factors.4.Establish an early warning model for patients with upper urinary tract stones complicated with urinary sepsis,and draw a receiver operating characteristic curve(ROC curve)based on the model.The area under the curve(AUC)is 0.854,with a asymptotic significance of 0.000,a 95%CI(0.791-0.913),and a maximum Youden index(YI)of 0.78.At this point,the corresponding sensitivity is 88%,and the specificity is 93%.The constructed early warning model has high diagnostic value.CONCLUSION:1.Age(≥65 years old),gender(female),previous history of stone surgery,maximum transverse diameter of stones(≥10mm),CT value of hydronephrosis(>10Hu),platelet count(<150×10~9/L),blood C-reactive protein(≥50mg/L),blood Calcitonin(≥10ug/L),and urine nitrite(positive)were independent risk factors for urinary sepsis in patients with upper urinary tract stones.The logistic regression warning model established based on clinical data analysis can effectively predict the risk of urinary sepsis in patients with upper urinary tract stones.2.The urine culture results of patients with upper urinary tract stones and urinary sepsis are mainly Gram negative bacteria,with the main pathogenic bacteria being Escherichia coli.