Construction of a back propagation neural network model for predicting urosepsis after flexible ureteroscopic lithotripsy based on heparin-binding protein and C-reactive protein levels.

Abstract

To analyze the association of serum heparin-binding protein (HBP) and C-reactive protein (CRP) levels with urosepsis following flexible ureteroscopic lithotripsy (FURL) and to construct a back propagation neural network prediction model. A total of 428 patients with kidney stones who underwent FURL were enrolled. Patients were divided into sepsis group (n=42) and control group (n=386) according to whether post-operative urosepsis developed. Logistic regression analysis was used to determine the risk factors and interactions of post-FURL urosepsis. A Logistic regression model and a neural network model were developed for predicting post-FURL urosepsis following FURL, and their predictive performance was evaluated using ROC curves. Univariate analysis showed that stone surgery history, gender, urine culture, stone diameter, diabetes, operation time, white blood cell (WBC), platelet, CRP, and HBP levels were significantly associated with post-FURL urosepsis (P<0.05). Multivariate analysis identified positive urine culture, CRP, and HBP levels as independent risk factors for post-FURL urosepsis (P<0.05). Interaction analysis revealed that CRP and HBP showed both additive (RERI=8.453, 95%CI: 2.645-16.282; AP=0.696, 95%CI: 0.131-1.273; S=3.369, 95%CI: 1.176-7.632) and multiplicative (OR=1.754, 95%CI: 1.218-3.650) interactions, while CRP and urine culture demonstrated multiplicative interaction (OR=2.449, 95%CI: 1.525-3.825). The neural network model showed superior predictive performance compared to the Logistic regression model. CRP and HBP levels are independent risk factors for post-FURL urosepsis. The neural network model based on CRP and HBP exhibits higher predictive accuracy than the Logistic regression model, which may provide a reliable risk assessment tool for early discrimination and intervention of post-FURL urosepsis.