| Objective:To analyze the composition of urinary calculi in single center in Hainan,and to explore the clinical characteristics of infectious calculi and the correlation with urosepsis after operation.To provide theoretical basis for clinical early warning of the occurrence and intervention of urosepsis associated with infectious stones.Materials and methods:1567 patients with urinary calculi were treated in Haikou people’s Hospital from January 2014 to December2020,and the stone composition was analyzed by automatic infrared spectroscopy system.One or more components of stones containing magnesium ammonium phosphate,carbonate apatite or ammonium urate are defined as infectious stones.Among the 1567 cases,902 patients with complete clinical data were divided into infectious stone group(n=554)and non-infectious stone group(n=348)to explore the clinical characteristics and related risk factors of infectious stone.554 patients with infectious calculi were divided into sepsis group(49 cases)and non-sepsis group(505 cases)according to the occurrence of urosepsis after operation.The correlation between infectious stones and postoperative urosepsis was analyzed.Results:(1)Among the 1567 patients with calculi,there were 1061males(67.71%)and 506 females(32.29%),with a male to female ratio of2.1:1.The age ranged from 15 to 85 years old,with an average of(50.16±12.86)years old.(2)Among the 1567 stone components,182 single-component stones(182 cases,11.6%)and 1385 mixed-component stones(1385cases,88.4%)were included.Anhydrous uric acid is the most in single-component stones(91 cases),and calcium oxalate monohydrate+calcium oxalate dihydrate+carbonated apatite are the main components in mixed-component stones(631 cases).There were 961 cases of stones containing infectious components.(3)In 902 patients with complete clinical data,compared with non-infectious stones,the infectious stone group had a higher incidence of fever(x~2=8.332,p=0.004),higher urinary p H(τ=4.320,p=0.010)、positive urine culture(x~2=6.130,p=0.013)and high stone load(x~2=8.463,p=0.015).Therefore,fever,high stone load,high urine p H and positive urine culture are independent risk factors for infectious stones.(4)There were 49 cases of urosepsis in 554 patients with infectious stones and 16 cases in 348 patients with non-infectious calculi.The difference between the two groups was statistically significant(x~2=5.765,p=0.016),in which there was a significant difference in the incidence of sepsis between the SAMP group and the Dah group(x~2=11.141,p=0.001).Multivariate Logistic regression analysis showed that the independent risk factors of urosepsis in patients with infectious stones included positive urine culture(p=0.001,OR=1.687,95%CI:1.861-8.022),T2DM(p=0.001,OR=4.511,95%CI:1.812-11.228),high stone load(p=0.043,OR=2.558,95%CI:1.032-6.496),long operation time(p=0.036,OR=2.353,95%CI:1.057-5.241),intraoperative blood transfusion(p=0.014,OR=3.862,95%CI:1.337-10.706).Conclusions:(1)Most of the patients with urinary calculi in this region are male,and the peak age of onset was from 40 to 59 years old.The stone components are mainly composed of a variety of mixed components,and mixed stones containing infectious stone components are the most common.(2)Patients with fever,high stone load,high urine p H,positive urine nitrite and positive urine culture are more likely to suffer from infectious stones.(3)Patients with infectious stones are prone to urosepsis after operation,and the incidence of urosepsis in patients with magnesium ammonium phosphate stone is significantly higher than that in patients with carbonate apatite stones.The incidence rate of urosepsis increases higher when patients are complicated with positive urine culture,T2DM,high stone load,long operation time,intraoperative blood transfusionand so on. |
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