MP75-17 C-REACTIVE PROTEIN AND ERYTHROCYTE SEDIMENTATION RATE PREDICTS SIRS AFTER PERCUTANEOUS NEPHROLITHOTOMY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-17 C-REACTIVE PROTEIN AND ERYTHROCYTE SEDIMENTATION RATE PREDICTS SIRS AFTER PERCUTANEOUS NEPHROLITHOTOMY Vishnu Ganesan, Robert Brown, Juan Jimenez, Shubha De, and Manoj Monga Vishnu GanesanVishnu Ganesan More articles by this author , Robert BrownRobert Brown More articles by this author , Juan JimenezJuan Jimenez More articles by this author , Shubha DeShubha De More articles by this author , and Manoj MongaManoj Monga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2165AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To test the hypothesis that high levels of pre-operative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are associated with an increased risk of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). METHODS Retrospective cohort study of patients who underwent percutaneous nephrolithotomy at our institution between October 2012 and October 2013 when ESR and CRP levels were part of our standard pre-operative order set. The primary endpoint was the development of SIRS postoperatively; defined as having 2 of the following: temperature >38C or <36C, heart rate >90 beats per minute, respiratory rate >20 breaths per minute or WBC count >12,000 cells/uL or <4000 cells/uL. Multivariable logistic regression was used to evaluate the association between ESR, CRP and the development of SIRS while controlling for potential confounders. Receiver operating characteristics curves were used to evaluate the discriminative ability of the test and identify the optimal cut-offs which maximized sensitivity and specificity. RESULTS Among the 107 PCNLs performed during the study period, 35 (33%) of patients had evidence of SIRS during the post-operative stay. Patients who experienced SIRS had a longer operative time (99 min vs. 85 min, p = 0.016), were more likely to have been transferred to the intensive care unit (ICU) (15% vs. 0%, p = 0.002) and experience a longer length of stay (median 2 days vs. 1 day, p < 0.001). On multivariable analysis controlling for operative time and the presence of a positive pre-operative urine culture, both ESR (odds ratio [OR] 1.32, 95% confidence interval [CI], 1.01-1.72, p = 0.04) and CRP (OR 1.59; 95% CI, 1.07-2.37, p = 0.02) were associated with development of SIRS. Among patients without a positive urine culture, an ESR >6.5 mm/hr (AUC 0.62; 95% CI, 0.52-0.78) had sensitivity, specificity, and negative predictive value of 70.4%, 61.5%, and 80.0% respectively, for development of SIRS. Among all patients, a CRP >0.65 mg/dL (AUC 0.63; 95% CI, 0.51 to 0.74) had sensitivity, specificity, and negative predictive value of 51.4%, 69.4%, 74.6%. The combination of a high ESR and CRP using the previously described thresholds demonstrated a lower sensitivity at 31% and higher specificity at 78%. CONCLUSIONS A preoperative blood test for ESR and CRP was predictive for the development of SIRS after PCNL. This knowledge could be used to risk-stratify patients and guide duration of antibiotic prophylaxis prior to PCNL, particularly among those without a positive urine culture. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1010 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Vishnu Ganesan More articles by this author Robert Brown More articles by this author Juan Jimenez More articles by this author Shubha De More articles by this author Manoj Monga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...