A Survey Of The Current Status Of Intraoperative Glucocorticoid Use In Single-center PCNL And Its Effect On 12 Cytokines In The Postoperative Period

Objectives: To investigate whether the use of low-dose glucocorticoids in PCNL can reduce the degree of infection in postoperative patients and its related mechanisms.Methods: This was a single-center,retrospective case-control study.(1)The data of1137 patients admitted to the First Affiliated Hospital of Kunming Medical University for percutaneous nephrolithotomy and lithotripsy from January 2019 to January 2022 were retrospectively analyzed,including 617 cases in the control group and 520 cases in the glucocorticoid group.Both groups underwent percutaneous nephrolithotomy with routine perioperative preparation,and glucocorticoids(dexamethasone 5 mg or methylprednisolone 40 mg or dexamethasone 10 mg or dexamethasone 5 mg +methylprednisolone 40 mg)were used during the operation in the glucocorticoid group;no hormone was used in the control group.Preoperative demographic data(age,sex,hypertension,history of diabetes,body mass index),laboratory test data(preoperative urine leukocyte count,preoperative urine nitrite,preoperative and postoperative blood leukocyte count,preoperative and postoperative blood neutrophils,preoperative liver and kidney function,postoperative C-reactive protein,postoperative calcitonin gene),imaging data(stone size,whether deerstalker type stones,degree of hydronephrosis,stone location,unilateral and bilateral stones),surgical data(operation time,intraoperative medication),postoperative data(incidence of postoperative systemic inflammatory response syndrome,postoperative fever rate,postoperative fever temperature,postoperative hospitalization days and postoperative antibiotic use days,postoperative glucocorticoid-related adverse reactions).(2)To retrospectively analyze the data of 82 patients admitted to the First Affiliated Hospital of Kunming Medical University for percutaneous nephrolithotomy and lithotripsy from June 2022 to October 2022,patients were divided into control and glucocorticoid groups according to whether they used glucocorticoids intraoperatively,including 30 cases in the control group and 52 cases in the glucocorticoid group.Preoperative demographic information,laboratory tests,imaging data,surgical data,and preoperative serum 12 cytokines,two-hour postoperative serum 12 cytokines,and 1-day postoperative serum 12 cytokines levels were collected from the patients.Using SPSS 27 software,the mean ± standard deviation(s(?))was used to satisfy the normal distribution,and the non-normally distributed data were expressed as median(interquartile spacing).Categorical data were described using the number of cases and percentages(%).The comparison of the measurement data was performed using independent samples t-test;categorical variables data were analyzed using the chi-square test.Logistic regression was used to further analyze items that were significant in the univariate analysis and to further analyze independent risk factors for the development of SIRS after PCNL.Results:(1)From January 2019 to January 2022,1001 patients were included,of which 16 patients in the glucocorticoid group had adverse reactions related to hormone use;the glucocorticoid group was compared with the control group in general data,in terms of gender,hypertensive disease,diabetes,preoperative creatinine,preoperative AST,preoperative ALT,preoperative WBC,preoperative blood neutrophils,preoperative urine culture,the degree of hydronephrosis,stone location,unilateral/bilateral stones,BMI,fever temperature,antibiotic use time,hospitalization time,and postoperative PCT were not statistically different(p > 0.05);the differences between the two groups in age,stone size,operation time,postoperative C-reactive protein,postoperative hospitalization time,antler-type stones,postoperative WBC,and postoperative blood neutrophils were statistically significant(p < 0.05).The incidence of fever and SIRS in the glucocorticoid group was 22.2%(105/472)and 12.9%(61/472),respectively,while the incidence of fever and SIRS in the control group was 43.1%(228/529)and 26.7%(141/529),respectively(p < 0.001).logistic regression analysis showed that stone size,operative time,preoperative urine leukocyte count,and preoperative urinary nitrite positivity were independent risk factors for the development of SIRS after surgery,while intraoperative use of low-dose glucocorticoids was a protective factor for the development of SISR after surgery(p < 0.05).When grouped according to the type and dose of intraoperative glucocorticoids used,the four groups differed significantly in postoperative fever rate and SIR’s incidence,with significant differences in fever rate(dexamethasone 5 mg group < methylprednisolone 40 mg group;dexamethasone 5 mg group <dexamethasone 10 mg group)and SIRS(dexamethasone 5 mg < methylprednisolone40 mg group;dexamethasone 5 mg group < dexamethasone 10 mg group)were statistically different(p < 0.05).There was no statistical difference in the incidence of SIRS and fever between the combination group and the other groups(p > 0.05).(2)From June 2022 to October 2022,a total of 82 patients were included,and in the comparison of general information,the glucocorticoid group had a longer operation time than the control group(p < 0.001),while the rest of the general information was not statistically different(p > 0.05).The incidence of postoperative SIRS was 15.3%(8/52)in the glucocorticoid group,compared with 36.6%(11/30)in the control group(p=0.028),and IL-10 was higher in the glucocorticoid group than in the control group two hours after surgery(p=0.007),while IL-6 and IL-8 were higher in the control group than in the glucocorticoid group one day after surgery(p= 0.024,p=0.032),and the rest of cytokines were not statistically significant between the two groups of patients(p>0.05).Conclusions:(1)Low-dose glucocorticoids are safer when used intraoperatively in PNCL,significantly reduce the risk of postoperative SIRS and fever,and reduce the length of stay in PCNL patients.(2)Operative time,stone size,preoperative positive urinary nitrite,and preoperative urinary leukocyte count were independent risk factors for postoperative SIRS,while intraoperative use of low-dose hormones was a protective factor.(3)Intraoperative administration of glucocorticoids promoted the release of the early anti-inflammatory factor IL-10 and reduced the release of the subsequent pro-inflammatory factors IL-6 and IL-8,thereby suppressing the late excessive inflammatory response.