Clinical Value Of Combined Detection Of Procalcitonin And Endotoxin In Early Diagnosis Of Postoperative Urosepsis After Percutaneous Nephrolithotomy

Objective:To evaluate the clinical value of serum procalcitonin(PCT) combined endotoxin(ET) detection in early diagnosis of postoperative urosepsis after percutaneous nephrolithotomy(PCNL). Methods:From(Jan 2010 to Dec 2015)the clinical data of 427 patients with upper urinary tract stones undergoing PCNL in our hospital. According to the EAU Guidelines(2015 edition),they were 49 patients with postoperative urosepsis and 378 patients without postoperative urosepsis after PCNL. We detected serum ET and PCT levels of one day preoperative and 2 hours from the start of the operation. And calculate the mean and standard deviation of the two groups of patients PCT and ET, data comparison in the group with paired t test, P < 0. 05 for the difference is statistically significant; Data comparison between groups using independent sample t test, P < 0. 05 for the difference is statistically significant; Evaluation of PCT and ET in the diagnosis of urosepsis after PCNLby R0 C curve, calculation of R0 C area under curve(AUC). ROC curve was used to analyse the results about PCT, ET level and combination of the two after PCNL. Results:The preoperative urosepsis group and the control group(without urosepsis group) PCT and ET levels had no significant difference. The postoperative urosepsis group PCT and ET levels were 5.18±4.43ng/ml、50.91±35.45pg/ml, and the control group PCT and ET levels were 1.38±1.01ng/ml、17.86±10.78ng/ml. Levels of PCT and ET significantly increased in urosepsis group(P <0.01). The PCT, ET level and combination of the two were analyzed by operating characteristic curve(ROC). According to ROC, PCT level at 2.085 ng/ml could distinguish urosepsis from non-urosepsis with sensitivity of 79.6%, specificity of 78.0% and the area under the curve(AUC) of 0.841±0.038. ET at 21.754 pg/ml was used to distinguish urosepsis from non-urosepsis with sensitivity of 71.4% and specificity of 70.1%, while AUC of 0.786±0.043. When combined PCT and ET, the AUC was 0.915±0.029, the sensitivity was 85.7%, specificity was 86.5%. Conclusion:ROC analysis shows that the sensitivity and utility could be increased by the combination of PCT and ET in early diagnosis of postoperative urosepsis after PCNL, it is better than PCT or ET individual detection.