The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following
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ORIGINAL ARTICLE
The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini‑percutaneous nephrolithotomy Zewu Zhu1 · Yu Cui1 · Huimin Zeng1 · Yongchao Li1 · Feng Zeng1 · Yang Li1 · Zhiyong Chen1 · Chen Hequn1 Received: 26 July 2019 / Accepted: 3 December 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose To identify early predictive factors for urosepsis secondary to mini-percutaneous nephrolithotomy (MPCNL) in patients with negative preoperative urine culture (UC). Methods A total of 786 patients with baseline negative UC who underwent MPCNL between January 2017 and June 2019 were retrospectively analyzed. Urosepsis was defined according to the Sepsis-3 definition. Subsequently, perioperative potential risk factors were compared between non-urosepsis and urosepsis groups. Results Despite negative UC in all patients, the rate of positive stone culture (SC) was 16.0%; the rate of pelvic urine culture (PUC) was 7.5%; 23 cases (2.9%) developed urosepsis after MPCNL. Univariate analysis showed that urosepsis was associated with the female gender, BMI, stone burden, diabetes mellitus and preoperative urine test. Multivariate logistic regression analysis suggested that urine test with positive nitrite and white blood cells and leukocyte esterase (N+WBC+LE+) (OR 17.51, 95% CI 6.75–45.38, P 120 min (OR 3.53, 95% CI 1.41–8.85, P = 0.007) were independent risk factors for urosepsis. Additionally, receiver operating characteristic curve analysis of N+WBC+LE+ showed that the area under the curve was 0.785 for predicting the occurrence of urosepsis. Further analysis showed that N+WBC+LE+ provided an efficient prediction of SC+/PUC+ (SC+ or PUC+) with 61.7% sensitivity and 97.3% specificity. Conclusions In spite of the baseline negative preoperative UC, 2.9% of patients developed urosepsis after MPCNL. N+WBC+LE + was determined to be an early and efficient prediction of intraoperative bacterial status and urosepsis following MPCNL. Nevertheless, further studies are needed to confirm the results. Keywords Renal stone · Urosepsis · Percutaneous nephrolithotomy
Introduction Percutaneous nephrolithotomy (PCNL) has become the firstline treatment for > 2 cm renal stones, since its introduction in 1976 [1]. Though there has been advancement in endourological instrumentation, postoperative fever, urosepsis and bleeding are common complications following PCNL [2]. The incidence of urosepsis was reported to be 0.3–4.7% [3], Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-019-03050-9) contains supplementary material, which is available to authorized users. * Chen Hequn [email protected] 1
Department of UrologyXiangya Hospital, Central South University, Changsha 410008, Hunan, China
which can progress to septic shock with a mortality rate of 50–66% [4, 5]. Since urosepsis is the most common cause of death following PCNL [2, 3], predicting and minimizing the high risk of u
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