Risk Factors For Septic Shock After Endolithotripsy For Upper Urinary Tract Calculi

Objective: To investigate the risk factors that can predict which patient is likely to develop to septic shock after endoscopic lithotripsy for the upper urinary tract stones,so as to reduce the risk of septic shock with early intervention.Materials and methods: This was a single-center,retrospective case-control study.Thirty-six patients with septic shock after endoscopic lithotripsy in the Lanzhou University Second Hospital from January 2013 to June 2018 were selected as shock group,and 144 patients without shock after operation at the same time were selected as control group according to the principle of the same gender,age±3 years and the same operation way.A 1:4 individual matched case-control study was conducted.The demographic data(age,sex,height,weight,group,hypertension and diabetes mellitus etc),laboratory examination data(urine routine,blood routine,electrolyte,liver and kidney function,coagulation index,blood sugar etc),imaging data(stone size,location,left or right side,CT value,obstruction status etc.),operation data(operation way,operation time,Anesthesia way,operation site etc)were collected.Using SPSS 22.0 software and conditional logistic regression analysis model,the data were analyzed by univariate and multivariate analysis.Results: There were a total of 36 septic shock cases and 144 non-septic shock cases,and the mean age of the patients was 44.97±13.97 years old and 44.96 ±13.46 years old respectively.Among the shock group with 29 females and 7 males,nineteen cases of the stone located on the left side and the rest was in the right of the upper urinary tract.The control group included 116 females and 28 males,with 68 patients undergoing operation on the left side and 76 patients on the right side.Univariate conditional logistic analysis revealed that diabetes mellitus,absolute neutrophils,PLR,FIB,urinary nitrite,positive urine culture,multiple drug resistance,hydronephrosis > 2cm,operation time > 1h,intraoperative pyuria and preoperative hospital day length were risk factors for septic shock after endolithotripsy(P< 0.05).Multivariate conditional logistic regression analysis showed that the rate of positive urine culture(OR = 10.390,P < 0.001),FIB is higher(OR = 2.008,P = 0.004),operation time > 1 h(OR = 7.100,P = 0.005),hydronephrosis > 2 cm(OR = 3.615,P = 0.012)were significant independent risk factors for septic shock after endolithotripsy surgery.Conclusion: The independent risk factors were operation time > 1 h,the rate of positive urine culture,FIB,hydronephrosis > 2 cm,which affected the occurrence of septic shock after endolithotripsy.Patients with positive urine culture should receive active anti-infection treatment before surgery;patients with hydronephrosis should be relieved of obstruction in time.Surgeons should shorten operation time by improving surgical techniques,monitoring blood analysis indicators and urinalysis results after surgery,early detection of the occurrence of septic shock through clinical manifestations and auxiliary examination,and timely intervention and prevention of disease progression,so as to reduce the incidence of septic shock and mortality after intracavitary lithotripsy.