Risk Factors Analysis Of Ureteral Calculi Patients Complicated With Urosepsis

Objective:To analyze the risk factors for urosepsis in patients caused by ureteral calculi and to develop a regression model for predicting probability of urosepsis.Finally,to offer clinical evidence for the prevention and treatment of urosepsis in patients with ureteral calculus.Methods:472 cases of ureteral calculi patients admitted to the Second Hospital of Tianjin Medical University from January 2016 to January 2018 were collected.Among them,39 cases complicated with urosepsis,while 433 cases without urosepsis were selected as the control group.Single factor analysis and multivariate unconditional logistic regression analysis were performed.Finally,we established a Logistic regression predictive model for assessing development of urosepsis.Results:The results of urine culture in patients with ureteral calculi complicated with urinary sepsis were mainly gram negative bacteria,especially escherichia coli.Single factor analysis showed that gender,diabetes mellitus,operation history of urinary calculi,stones size,WBC,neutrophils proportion,CRP and PCT,blood albumin,serum creatinine,urine occult blood,urine routine WBC and urine nitrite and urine culture results were significant difference between case group and control group(P < 0.05).logistic regression analysis revealed that there were 7 significant factors for urosepsis in patients caused by ureteral calculi,and in order of the degree of risk including urine culture results(OR=7.375,P =0.003),previous urinary calculus surgery history OR=3.455,P=0.023),gender(OR=3.176,P=0.014),urinary nitrite results(OR=3.023,P=0.037),stone size(OR=2.31,P=0.008),CRP(OR=2.039,P=0.024)and PCT value(OR=1.149,P=0.043).Finally,Logistic regression predictive model for development of urosepsis were established.The area under the receiver operating characteristic curve(ROC)of the predictive model was 0.818±0.017(P<0.001,95%CI: 0.785-0.851).Conclusion:The results of urine culture in patients with ureteral calculi complicated with urinogenic sepsis were mainly gram-negative bacteria,which had a reference value for the use of preoperative antibiotics.The occurrence of urosepsis in patients with ureteral calculi may be related to a variety of factors including positive urine culture,previous history of urinary calculi surgery,female patients,positive urine nitrite,heavy stone load,increased CRP and PCT.The Logistic regression model established based on the analysis of clinical data of patients can better predict the probability of urosepsis in patients with ureteral calculi.