Abstract
ObjectiveTo analyze the risk factors of patients with diabetes mellitus (DM) and urosepsis after percutaneous nephrolithotomy (PCNL) for upper urinary tract stones and to develop a nomogram to predict postoperative urosepsis according to the risk factors.MethodsThe data of patients with type 2 diabetes who underwent one-stage PCNL due to upper urinary tract stones were retrospectively analyzed. The risk factors of patients with postoperative urosepsis were evaluated by univariate and multivariate logistic regression analysis, and the nomogram prediction model was developed according to the regression coefficient.ResultsOne-stage PCNL was successfully completed in 241 patients with DM, and urosepsis occurred in 41 (17.0%) patients after PCNL. Based on multivariate logistic regression analysis, the independent risk factors associated with postoperative urosepsis included preoperative leukocyte elevation (OR = 3.973, P = 0.005), positive urine nitrite (OR = 3.697, P = 0.010), and positive urine culture (OR = 3.562, P = 0.002). According to the results of the logistic regression analysis model, staghorn stones (OR = 2.049, P < 0.1) and complete intraoperative stone clearance (OR = 0.431, P < 0.1), were used to develop the nomogram. Internal validation of the nomogram showed that the concordance index (C-index) was 0.725. Additionally, the Hosmer–Lemeshow test was performed, P = 0.938 > 0.05.ConclusionPreoperative leukocyte elevation, positive urine nitrite, and positive urine culture are independent risk factors for urosepsis after one-stage PCNL for patients with DM with upper urinary tract stones. The nomogram, which is based on independent risk factors that combine stone morphology and intraoperative stone clearance, can help predict the risk of postoperative urosepsis.
Highlights
After decades of development, percutaneous nephrolithotomy (PCNL) has become one of the main surgical methods for upper urinary tract stones, especially thoseUrosepsis is a serious postoperative complication of PCNL
Patients We retrospectively analyzed the data of patients who underwent one-stage PCNL for upper urinary tract stones and were preoperatively diagnosed with type 2 diabetes mellitus(T2DM) at the Urology and Lithotripsy Center of Peking University People’s Hospital between June 2012 and December 2019
Diagnosis of Type 2 diabetes mellitus (T2DM) was defined by 2-h Two-hour 75-g postload plasma glucose level (PG)(two-hour 75-g postload plasma glucose level) ≥ 11.1 mmol/L on Oral glucose tolerance test (OGTT)(oral glucose tolerance test) or Fasting plasma glucose (FPG)(fasting plasma glucose) ≥ 7.0 mmol/L according to ADA(American Diabetes Association) criteria, or a previous diagnosis of T2DM
Summary
Percutaneous nephrolithotomy (PCNL) has become one of the main surgical methods for upper urinary tract stones, especially those. Urosepsis is a serious postoperative complication of PCNL. Clinical studies have shown that diabetes mellitus was independently associated with increased risk of infectious complications after PCNL(OR = 14.6, P = 0.001) [5]. This study retrospectively analyzed clinical data of patients with DM submitted for primary PCNL treatment for upper urinary tract stones at the Urology and Lithotripsy Center of Peking University People’s Hospital, as well as the independent risk factors for urosepsis after PCNL. A prediction model for postoperative urosepsis was developed for early detection of urosepsis in patients with DM when performing PCNL, as well as prevention and early intervention
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