Clinical Significance Of Plasma Procalcitonin In The Early Diagnosis Of Urinary Sepsis Secondary To Percutaneous Nephrolithotomy

Objective:Nowadays, percutaneous nephrolithotomy (PCNL) is very commonly used for patients with complicated upper urinary tract stones. Some of these pateints suffer from urosepsis secondary to PCNL, which may result in severe poor prognosis. We monitored the rising plasma procalcitonin (PCT) of the patients who underwent PCNL and evaluated the role of PCT in early diagnosing urosepsis secondary to PCNL.Methods:We retrospectively reviewed the preoperative and postoperative (within6hours and at about24hours after PCNL) records of PCT and C-reactive protein (CRP) of98patients respectively who underwent PCNL for upper urinary tract calculi between January2012and November2013. All patients were divided into two groups:48cases in observation group were diagnosed as urosepsis secondary to PCNL within6hours after the surgery according to the EAU Guidelines (2013edition), and the others50age-, gender-and stone-matched subjects who did not have the systematic symptoms of urosepsis were enrolled as a control group. All data were analyzed using pair T test and group T test. And we used receiver operating characteristic (ROC) curve to evaluate the roles of PCT and CRP in early diagnosing the urosepsis secondary to PCNL.Results:There were not statistically differences between the preoperative data of both two groups. However, the levels of postoperative PCT (3.910±2.010ng/ml within6h after PCNL) in observation group were higher than control group (1.354±0.310ng/ml within6h after PCNL)(P<0.01). The levels of postoperative CRP (38.67±10.73mg/1within6h after PCNL) in observation group were also higher than control group (38.67±10.73mg/1within6h after PCNL)(P<0.01). But the ROC curve showed that the area under the ROC curve (AUC) of PCT was larger than CRP (AUC-PCT:0.983, AUC-CRP:0.874, P<0.05), which indicated that PCT was more effective than CRP in early diagnosing urosepsis secondary to PCNL. And according to the results of ROC curve, we calculated the optimal cut-off point of PCT for diagnosing urosepsis was1.64ng/ml.Conclusions:PCT is a useful warning marker for urosepsis secondary to PCNL, and it is more effective and reliable than CRP in early diagnosing urosepsis secondary to PCNL. It is helpful for urologists to detect the postoperative PCT within6h after PCNL so as to improve the prognosis of patients with urosepsis secondary to PCNL.