Risk Factors And Prediction Model For Systemic Inflammatory Response Syndrome After Flexible Ureteroscopic Holmium Laser Lithotripsy

Objective:To investigate the risk factors for systemic inflammatory response syndrome（SIRS）after Holmium laser lithtripsy with flexible ureteroscopic and to establish prediction model.Logistic multivariate regression analysis was used to screen out the independent risk factors for SIRS in upper urinary stone patients receiving Holmium laser lithtripsy with flexible ureteroscopic,which provided an objective basis for medical staff,and finally construct a prediction model and data visualization to evaluate the probability of SIRS after surgery,provide posictive guidance for medical assessment and condition observation,and reduce the incidence of SIRS after Holmium laser lithtripsy with flexible ureteroscopic.Methods:In this study,retrospective data were used to establish a predictive model study design.The clinical case data of patients who underwent Holmium laser lithtripsy with flexible ureteroscopic in the Department of Urology of Huaihe Hospital of Henan University from January 2021 to December 2021 were collected and analyzed,and a total of 225 patients met the inclusion criteria,which were divided into two groups according to whether SIRS occurred after surgery,with a total of 18 patients with SIRS and 207 patients without SIRS.Based on domestic and foreign studies and the clinical experience of our hospital,the following factors were included in this study that are closely related to the occurrence of SIRS after Holmium laser lithtripsy with flexible ureteroscopic surgery,including age,gender,previous urological surgery,history of alcohol consumption,smoking history,body mass index（BMI）,diabetes mellitus,operation time,maximum stone diameter,number of stones,stone location,stone load,urine leukocytes,urine nitrite,preoperative mid-urine culture results,preoperative platelet count,preoperative eosinophil count is associated with 17 risk factors.Using SPSS25.0 statistical software,firstily,univariate logistic regression analized all the above factors,with P<0.1 as the standard,and combined with literature records and clinical experience to initially screen the variables and screen out the variables with statistical significance in the occurrence of SIRS after Holmium laser lithtripsy with flexible ureteroscopic.Secondly,multivariate logistic regression was used to analyze the above statistically significant variables,and the independent risk factors for SIRS after Holmium laser lithtripsy with flexible ureteroscopic surgery were obtained,and P<0.05 indicated that the difference was statistically significant,and the results were substituted into the equation to establish a prediction model and construct a nomogram.Finally,the receiver working characteristic curve,calibration curve and decision analysis curve were constructed to verify the nomogram model and evaluate its clinical application value.Results:Univariate logistic regression analysis showed that age,gender,diabetes,maximum stone diameter,stone CT value,operation time（min）,and positive preoperative mid-urine culture results were all closely related to SIRS after Holmium laser lithtripsy with flexible ureteroscopic（P<0.1）.Logistic regression analysis showed that gender（OR=5.474,95%CI:1.383-21.672,P=0.015）,diabetes mellitus（OR=7.882,95%CI:1.752-35.457,P=0.007）,maximum stone diameter（OR=1.207,95%CI:1.004-1.452,P=0.045）,preoperative mid-urine culture results（OR=6.027,95%CI:1.546-23.497,P=0.01）,preoperative platelet count（×10⁹/L）（OR=1.009,95%CI:1.001-1.017,P=0.021）were independent risk factors for SIRS after Holmium laser lithtripsy with flexible ureteroscopic surgery（P<0.05）.The prediction model constructed in this institute is Logit（P）=-12.388+1.700X₁+2.065X₂+0.188X₃+1.796X₄+0.009X₅.Among them,X₁is gender（female）,X₂is diabetes mellitus（available）,X3 is stone maximum diameter,X₄is preoperative mid-urine culture results（bacterial,positive）,X₅is pr eoperative platelet count.Finally,the predictive model is evaludted:The area under the receiver ope rating characteristic curve was 0.911.Hosmer-Lemeshow tested that the model was valid and had good prediction performance（P>0.05）.The decision analysis curve shows that the model has good application value.Conclusions:Gender（female）,diabetes mellitus（available）,maximum stone diameter,preoperative mid-urine culture results（bacterial,positive）,and preoperative platelet count are independent risk factors for SIRS after Holmium laser lithtripsy with flexible ureteroscopic.The prediction model and data visualization based on the above five indicators can provide guidance for medical staff to make sufficient preoperative preparation for patients with high-risk factors to a certain extent.In clinical work,for patients who are to undergo Holmium laser lithtripsy with flexible ureteroscopic and are accompanied by the above risk factors,make sufficient preparations before surgery,achieve early detection and early treatment after surgery,reduce the incidence of SIRS after Holmium laser lithtripsy with flexible ureteroscopic surgery,and prevent further more serious complications after the occurrence of SIRS.