Establishment And Study Of Risk Assessment Scoring System For Urosepsis After Percutaneous Nephrolithotomy

Objective To establish and evaluate the risk asswssment scoring system for urosepsis after percutaneous nephrolithotomy(Pu Rass).Method1.Published studies concerning risk factors about urosepsis after PCNL were systemically searched from January 2006 to December 2016 for meta-analysis,to synthetically evaluate the risk factors related to urosepsis after PCNL.2.According to the meta-analysis,the scores were assigned to the risk factors with a standard of their degree of association,Pu Rass model was established,and retrospectively validate and evaluate its clinical application value.3.The patients who underwent PCNL surgeries were perspectively studied with using Pu Rass model to predict their risks of infection after PCNL,and analyzed the difference between predictive value and observed value.Result1.18 case-control studies were selected for meta-analysis,including 14 chinese studies and 4 English studies.12 factors were analyzed,9 factors had statistical significances.Urosepsis-related factors were as fo1 lows,female OR=3.89(95%CI[2.07,7.31]),age(≥60Y)OR=1.71(95%CI[1.23,2.39]),diabetes mellitus OR=3.15(95%CI[2.10,4.72]),blood routine(White blood cells≥10×109/L)OR=2.86(95%CI[1.66,4.92]),Urine routine(White blood cells≥+)OR=2.43(95%CI[1.35,4.37]),Urobacterial culture(Positive)OR=1.60(95%CI[1.12,2.29]),stone size(≥2cm)OR=1.94(95%CI[1.49,2.54]),Staghorn stone OR=3.07(95%CI[1.78,5.31]),Hydronephrosis(moderate-severe)OR=1.57(95%CI[1.02,2.43]).2.The risk asswssment scoring system was established by giving female,age(≥60Y),diabetes mellitus,blood routine(White blood cells≥10×109/L),Urine routine(White blood cells≥+),Urobacterial culture(Positive),stone size(≥2cm),staghorn stone,hydronephrosis(moderate-severe)3,2,3,2,2,2,2,3,2 points based on the OR value.The total score was 21 points.The area under the ROC curve is0.913,the best cut-off point at 8.5 sensitivity and specificity were 90% and 89.4% respectively.The Pu Rass model was divided into high-risk group(>8.5 points)and low-risk group(<8.5 points),according to the cut-off point.3.According to Pu Rass model,79 patients were predicted in preoperative,the results showed that 17 cases in high-risk group and 62 cases in low-risk group,15 cases had concurrent infection in postoperative,actually,13 cases in high-risk group,2 cases in low-risk group,1 of them progressed to urosepsis.There is no significant difference between the forecast group and the actual group(P>0.05).The area under the ROC curve is 0.934,95%CI(0.934~1.000).Conclusion1.female,age(≥60Y),diabetes mellitus,blood routine(White blood cells≥10×109/L),Urineroutine(White blood cells≥+),Urobacterial culture(Positive),stone size(≥2cm),staghorn stone,hydronephrosis(moderate-severe)are risk factors for urosepsis after PCNL.2.The preoperative risk assessment scoring system can preliminarily assess the risk of urosepsis after PCNL surgery,clinicians should pay enough attention to the high risk patients with a score above 8.5during the perioperative period.3.The Pu Rass model can be used as a preoperative prediction tool for patients with urosepsis after PCNL.