Correlation Between Serum Albumin Level And Urosepsis After Flexible Ureteroscopy Lithotripsy

Purpose: To retrospectively investigate whether the changes in serum albumin(Alb)levels within one hour after flexible ureteroscopy(fURS)lithotripsy could be used as a predictor of postoperative urosepsis.Method and materials : Patients with unilateral upper urinary calculi who underwent fRUS lithotripsy performed by a single surgeon from January 2019 to September 2019 were included in the analysis.The patients were divided into the sepsis group and the non-sepsis group according to whether the patients developed urosepsis after the operation.There were 20 patients(6.4%)in the sepsis group,including 9 males and 11 females,with an average age of 57.3±8.4 years.There were 294 cases(94.6%)in the non-sepsis group,including 201 males and 93 females,with an average age of52.3 ± 12.9 years.Preoperative clinical data of the patients,including body mass index(BMI),major comorbidities,fever caused by urinary tract infection within six months,carrying a ureteral stent before surgery,the results of routine urine examination and urine culture,the results of blood routine test and blood biochemical analysis were collected.The operative duration and infusion volume were recorded during the operation.Blood samples were collected from all patients within 1 hour after the operation to perform blood routine test and blood biochemical analysis,and the change ratio of white blood cells and serum albumin(representing the change amplitude of white blood cells and serum albumin)was calculated by using the postoperative/preoperative index ×100%.Collinear diagnosis was used to exclude variables with higher collinearity,univariate and multivariate logistic regression analyses were used to assess whether there was a correlation between risk factors and postoperative urosepsis.Then,for the factors that have significant differences in multivariate logistic regression analysis,the receiver operating characteristic(ROC)curve was used to analyze its predictive ability for postoperative urosepsis.Result: In the end,a total of 314 patients were included in the analysis,of which 20 patients had postoperative urosepsis,5 patients developed septic shock,and no deaths occurred.Univariate analysis showed the age(57.3±8.4 years and 52.3±12.9 years),gender(45% and 68.4% male),preoperative fever history(preoperative fever were20% and 4.4%),postoperative albumin levels(31.4 ±3.6 g/L and 37.5±3.8 g/L),ratio of albumin changes after surgery(76.6 ± 5.8% and 88.7 ± 8.0%)and urine culture results(positive urine culture were 40% and 18.2%)between the sepsis group and the non-sepsis group had significant difference(p < 0.05).The final multivariate logistic regression analysis showed that the urine culture results(OR: 4.667,95% CI:1.405-15.499,p = 0.012),white blood cell(WBC)counts within one hour after surgery(i.e.W2,OR: 0.697,95% CI: 0.480-0.959,p = 0.028),postoperative albumin levels(i.e.A2,OR: 0.817,95% CI: 0.669-0.997,p = 0.047)and ratio of albumin changes after surgery(i.e.A2/A1,OR: 0.849,95% CI: 0.769-0.937,p= 0.001)are independent predictors of postoperative urosepsis.ROC curve analysis shows that the combined analysis of A2 and A2 / A1 may have better predictive value.Conclusion: The combined analysis of serum Alb levels within 1 hour postoperatively and the magnitude of its changes relative to preoperative values can quickly predict the occurrence of postoperative urosepsis in patients undergoing fURS lithotripsy.