| BackgroundUrosepsis is a commom critical disease in urology with high mortality that caused by urogenital infection.Early warning for urosepsis is of great significance for early clinical intervention and improvement of prognosis.As a common indicator of severe infection,procalcitonin(PCT)is widely used in the diagnosis and prognosis of urosepsis.Endoscopic lithotripsy is one of the major risk factors of urosepsis.However,the early warning effect of PCT in urosepsis after endoscopic lithotripsy has not been reported yet.In this work,the early predictive value of PCT in urosepsis after endoscopic lithotripsy was retrospectivly studied,and the risk factors of urosepsis was analyzed.Material and MethodsThe clinical data of patients who underwent endoscopic lithotripsy in this center during Jan 2014 to Apr 2019 and received at least one PCT test within 4 hours after surgery were included in this retrospective study.,All the cases were divided into infection group and non-infection group according to the diagnostic criteria of SEPSIS 3.0 and SIRS.Basic information,vital signs,clinical test results,as well as the first PCT value and the highest PCT value within 48 hours after endoscopic lithotripsy were included in the data.Baseline statistics analysis were performed on the above mentioned indicators.Then the sensitivity and specificity of the two PCT tests were analyzed respectively to evaluate the effect of early prediction.Meanwhile,univariate analysis of the intraoperative and postoperative relavent indicators were performed.Further,combined with the characteristics of clinical data and P value,the risk factors related to the occurrence of urosepsis after endoscopic lithotripsy were analyzed by logistic regression analysis.ResultsIn this retrospective study,264 cases were included,with an average age of 56 years,including 103 women,accounting for 39%.Among them,73 were in the infection group,while the other 191 were in the non-infection group.There was no significant statistical difference between the infection group and non-infection group in the first PCT test value(0.05(0.05,0.1)μg/L vs 0.1(0.05,0.1)μg/L,P > 0.05),while the highest PCT values within 48 hours after operation was statistically significant between the two groups(0.2,8.25)μg/L vs 0.1(0.1,0.2)μg/L,P < 0.05).The AUC value of the ROC curve for the highest PCT test result within 48 hours after surgery was 0.819,with the 52.2% sensitivity and 99.5% specificity under the best cutoff value(<0.8 μg/L and ≥0.8 μg/L).The results of univariate analysis showed that there were significant statistical differences in gender,surgical type,stone site,stone size,operation time,postoperative SBP,postoperative LY,postoperative NEUT,postoperative Hb,postoperative LY%,reoperation statement and ICU treatment statement(P < 0.05).Indicators with P values <0.15 were selected to the next evaluation.Variance inflation factor(VIF)analysis was performed on variables with P <0.15,and the variables with VIF>10 were excluded.After coding categorical variables and setting dummy variables,the logistic regression analysis was performed.The results showed that the following variables: female,percutaneous nephrolithotripsy,higher postoperative SBP and longer operation time were considered as risk factors for urosepsis after endoscopic lithotripsy.Further,Hosmer and Lemeshow Test was utilized to test the goodness of fit,and the result was P= 0.786 which mean the fit was relatively good.Conclusion 1.PCT is not ideal indicator for the early prediction of urosepsis after endoscopic lithotripsy,but its diagnostic value is beyond doubt.2.Female and percutaneous nephrolithotripsy may increase the risk of urosepsis after endoscopic lithotripsy,and shorten the operation time can reduce the risk of urosepsis to some extent.Besides,early monitoring of blood pressure after endoscopic lithotripsy may detect the suspicious infection trends... |
PDF Full Text Request