| Objective: Analyze the risk factors of systemic response syndrome(SIRS)after flexible ureteroscopic lithotripsy(FURL).A risk prediction model for SIRS after FURL was constructed based on independent risks such as neutrophil-to-lymphocyte ratio(NLR),derived neutrophil-to-lymphocyte ratio(d NLR),and lymphocyte-tomonocyte ratio(LMR).Methods: The clinical data of 456 patients who received FURL treatment from January 1,2015,to October 31,2021,in Zhuhai People’s Hospital(Zhuhai Hospital Affiliated to Jinan University)was retrospectively analyzed.According to the inclusion and exclusion criteria,they were divided into the SIRS group(24),nonSIRS group(432).The independent risk factors of SIRS after FURL were found through univariate analysis and multivariate logistic regression.Calculate the area under the ROC curve for NLR,d NLR,LMR,and combined indicators.A Nomogram prediction model was constructed according to independent risk factors,and the prediction accuracy and performance of the model were evaluated by Hosmer Lemeshow and Area Under ROC Curve(AUC).Results: The results of the univariate analysis showed: hospital stay,hydronephrosis,preoperative urine bacterial culture,preoperative urine leukocyte positive,preoperative urine nitrite positive,preoperative leukocyte,granulocyte,lymphocyte,monocyte,platelet count,NLR,d NLR,LMR,PLR there were differences between groups,with statistical significance(P<0.05).Multivariate Logisti regression analysis results: hydronephrosis(OR: 3.035,95%CI: 1.058-9.81,p=0.048),preoperative urine bacterial culture(OR: 6.811,95%CI: 2.106-28.22,p=0.003),Preoperative urinary nitrite(OR: 3.893,95%CI: 1.28-12,p=0.016),preoperative white blood cell count(OR: 5.711,95%CI: 2.516-14.12,p<0.001,NLR(OR: 0.094,95%CI: 0.014-0.396,p=0.006),d NLR(OR: 7.157,95%CI: 2.526-24.29,p<0.001),LMR(OR: 0.092,95%CI: 0.012-0.443,p= 0.008)was statistically significant.The ROC curves of NLR,d NLR,LMR,and the combined indicators show that: the single indicator LMR has the highest diagnostic efficiency(AUC=0.812)and is higher than the detection efficiency of any combined indicator,and the combined indicator NLR+LMR has the highest diagnostic efficiency(AUC= 0.776)and higher than the single indicator NLR(AUC=0.771),and the other combined indicators were only higher than the diagnostic performance of d NLR.The Nomogram prediction model was constructed based on the above 7 independent risk factors for SIRS after FURL operation,the area under the curve: AUC=0.939,Hosmer Lemeshow test result: Chi-square=9.105,P=0.334.Conclusion: Preoperative hydronephrosis,positive preoperative urine culture,positive urine nitrite,preoperative peripheral white blood cell count>7.695×109/L,preoperative NLR,d NLR and LMR are independent risk factors for SIRS after FURL.Compared with the combined index in diagnosing the probability of SIRS after FURL,the single index LMR has the highest diagnostic efficiency and is higher than that of any combination index,the combined index NLR+LMR has the highest diagnostic efficiency and is better than NLR and d NLR alone efficacy.The Nomogram prediction model constructed in this study based on independent risk factors has good reliability and discrimination,and has a high predictive value for predicting the occurrence of SIRS after FURL surgery,which can provide help for clinical work. |
