Methylprednisolone Prevents Urosepsis In High-risk Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial

ObjectivesUrosepsis as a result of endourological procedures occurs abruptly and deteriorates quickly.This severe and usually life-threatening condition poses a challenge for clinicians in perioperative medicine.In view of its unique pathogenesis,namely the hyper-inflammatory response caused by the absorption of infected urine during surgery,anti-inflammatory therapy might be a promising avenue in the prevention of postoperative urosepsis.MethodsEighty patients who underwent PCNL with high-risk factors of postoperative urosepsis(e.g.,a history of upper urinary tract infection with calculous pyelonephritis,positive midstream urine[MSU]culture or white blood cell count in MSU≥500·u L^-1)were prospectively selected in this study.They were stratified by gender and randomized into MP or control groups（n=40 in each group）.After induction of general anesthesia,40 mg MP was intravenously administered in MP group before operation,while the equal volume of normal saline was done in the control group.The primary outcome was the incidence of postoperative urosepsis（according to Sepsis 3.0 definition）.The secondary outcomes included the incidences of uroseptic shock and system inflammatory response syndrome（SIRS）,and the changes of plasma levels of inflammatory markers（C reactive protein[CRP],procalcitonin,tumor necrosis factorα[TNF-α],interleukin[IL]-1β,IL-6,and IL-10）at 2 h and 24 h after operation.ResultsSix out of 80 patients were excluded.There was no significant difference in the baseline values between the two groups before operation（P>0.05）.The incidences of postoperative urosepsis,uroseptic shock and SIRS were 5.4%（2/37）,0 and 18.9%（7/37）in the MP group（n=37）,and 24.3%（9/37）,10.8%（4/37）and 51.4%（19/37）in the control group（n=37）,respectively,with no significant difference in the incidence of uroseptic shock（P>0.05）,but with significant differences in the incidences of urinary sepsis and SIRS between the two groups（P<0.05,P<0.01）.The plasma level of IL-10 in the MP group was higher than that in the control group at 2 h after operation(26.3[9.5-159.0]pg·m L^-1 vs.5.0[<5.0-8.6]pg·m L^-1,P<0.01),but lower than that in the control group at 24 h after operation(<5.0[<5.0-6.5]pg·m L^-1 vs.5.9[<5.0-18.8]pg·m L^-1,P<0.05).The plasma level of IL-6 in the control group was higher than that in the MP group at 24 h after operation(34.4[21.1-67.6]pg·m L^-1 vs.20.7[13.3-29.1]pg·m L^-1,P<0.01).No significant difference was found in the levels of other inflammatory markers between the two groups（all P>0.05）.ConclusionMP pretreatment can decrease the incidences of urosepsis and SIRS in high-risk patients undergoing PCNL.This protective effect might be attributed to MP pretreatment facilitating the release of IL-10 at the initial stage of inflammatory response,and then inhibiting the subsequent excessive inflammatory response.