Construction Of Urinary Tract Infection Risk Scoring Tool After Ureteroscopic Holmium Laser Lithotripsy

Urinary calculi is one of the most common diseases in urology clinic.In our country,the incidence of stones has increased gradually in recent years.Once they block the ureter or kidney,they will cause obstruction of urinary tract,resulting in slow renal blood flow measure,and then renal dysfunction,finally lead to renal failure.With the development of minimally invasive medical techniques and the understanding of diseases,the traditional open lithotripsy has been gradually replaced by ureteroscopic holmium laser lithotripsy.Ureteroscopic holmium laser lithotripsy is a minimally invasive operation with low trauma and high stone-clearing rate.However,urinary tract infections(UTI)are easy to occur after operation because of its invasive nature.Urinary tract infections(UTI)can not only prolong the hospital stay of patients,but also aggravate the changes in the course of disease.Cause unforeseeable damage.Therefore,early identification of high-risk groups of urinary tract infection after ureteroscopic holmium laser lithotripsy is particularly important.Currently,many scholars have focused on the causes of urinary tract infection,and there are not many assessment tools for urinary tract infection after ureteroscopic holmium laser lithotripsy.Therefore,it is necessary to construct a risk scoring tool suitable for ureteroscopic holmium laser lithotripsy patients to help nurses identify high-risk patients early,effectively improve the quality of care,and reduce the occurrence of disease complications.Accelerate the rapid recovery of patients.Objectives1.To investigate the risk factors of urinary tract infection after ureteroscopic holmium laser lithotripsy.2.To construct a urinary tract infection risk scoring tool after ureteroscopic holmium laser lithotripsy and conduct preliminary verification.3.To provide clinical nursing basis for high-risk patients with urinary tract infection after ureteroscopic holmium laser lithotripsy.MethodsCases of patients undergoing ureteroscopic holmium laser lithotripsy in a Class A hospital in Yichang City from 2018 to 2021 were collected as study samples.The study samples were randomly divided into a modeling group and a validation group according to the quantity of 70%vs30%.The former was used to construct a risk prediction model and form a scoring tool,and the latter was used for internal verification of the scoring tool.SPSS26.0 software was used for data analysis.The demographic and social data,disease status,and medical care behavior data of patients were collected,and the risk factors that may result in urinary tract infection after ureteroscopic holmium laser lithotripsy were analyzed.The modeling group used binary logistic regression to construct the analysis model,and used R language to construct the risk prediction model of urinary tract infection after ureteroscopic holmium laser lithotripsy.The Odds Ratio(OR)value obtained by binary logistic was used to construct the urinary tract infection risk scoring tool after ureteroscopic holmium laser lithotripsy.The scoring tool was used to verify the sample of the verification group.P<0.05 was considered to be statistically significant.Results1.A total of 458 patients after ureteroscopic holmium laser lithotripsy were included in this study,among which 102 patients developed urinary tract infection,with an incidence of 22.2%.2.Results of single factor analysisThere were 16 variables that were statistically significant with outcome index UTI(P<0.05):There were statistically significant differences in age,smoking history,diabetes history,chronic disease history,hydronephrosis,preoperative urinary tract infection history,preoperative serum protein level,azotemia,abnormal liver function,abnormal kidney function,intraoperative perfusion time,stone size,number of days with indent catheter,number of days with antibiotics,whether combined with antibiotics,and postoperative bladder irrigation time(P<0.05).3.Binary logistic regression analysis resultsIn the modeling group(320 cases),multivariate analysis showed that age ≥ 60 years old,history of diabetes,history of preoperative urinary tract infection,abnormal renal function,intraoperative perfusion time,combined use of antibiotics were the risk factors for urinary tract infection after ureteroscopic holmium laser lithotripsy,and the differences were statistically significant(P<0.05).The risk profile of UTI after ureteroscopic holmium laser lithotripsy showed that the risk of UTI increased with age,history of diabetes,preoperative urinary tract infection,renal dysfunction,intraoperative perfusion time,and combined antibiotic use.4.Risk scoring tool analysis resultsAccording to the risk factors,the scoring range of the risk scoring tool was 0-14 points,AUC=0.734,and when the Youden index was the maximum(0.411),the critical value(cut off)=6.5 points could be obtained.The scoring tool was divided into low-risk group(0-6 points)and high-risk group(7-14 points).According to the new stratification criteria,the incidence of UTI in the high-risk group and the low-risk group in the modeling group was divided into 11.4%and 11.4%,and the incidence of UTI in different risk groups was statistically significant(P<0.05).In the verification group,the incidence of UTI in the high-risk group and the low-risk group was 16.3%and 73.3%,and the difference was statistically significant(P<0.05).After ureteroscopic holmium laser lithotripsy,UTI risk scoring tool was used clinically,and the accuracy of the model was 86.8%,indicating that the UTI risk scoring tool was well used clinically.Conclusions1.This study found that age ≥ 60 years,history of diabetes mellitus,preoperative history of urinary tract infection,abnormal renal function,intraoperative perfusion time,and combined use of antibiotics were risk factors for urinary tract infection after ureteroscopic holmium laser lithotripsy.2.Based on the above independent risk factors,the total score of ureteroscopic holmium laser lithotripsy risk scoring tool for postoperative urinary tract infection ranges from 0 to 14 points,which can divide patients into low-risk group(0 to 6 points)and high-risk group(7 to 14 points)according to the risk of postoperative urinary tract infection.After internal verification,it is practical and feasible.