A Predicting Model Based on Risk Factors for Urosepsis after One-phase Percutaneous Nephrolithotomy

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INTRODUCTION

To analyze the risk factors that affect urosepsis following one-phase percutaneous nephrolithotomy (PCNL) for upper urinary tract calculus, and to construct the regression model and nomogram for predicting the probability of postoperative urosepsis.

METHODS

We retrospectively analyzed the clinical data from 405 cases of upper urinary calculi treated by one-phase PCNL between January 2013 and December 2016. The patients were divided into two groups as patients developing urosepsis or not. By a logistic regression model, univariate and multivariate statistical analyses were performed to determine factors affecting the development of postoperative urosepsis, then a nomogram was built based on regression coefficients.

RESULTS

The PCNL procedures of 405 cases were successful, and the incidence of urosepsis after PCNL was 7.9% (32/405). Multivariable logistic regression analysis identified diabetes mellitus history (OR = 4.511, P = 0.001), stone burden (OR = 2.588, P = 0.043), operation time (OR = 2.353, P = 0.036), irrigation rate (OR = 5.862, P = 0.000), and infectious stone composition (OR = 2.677, P = 0.036) as independent risk factors for postoperative urosepsis. The concordance index (C-index) was 0.834 in the nomogram model sample and 0.802 in the validation sample?

CONCLUSION

Diabetes mellitus history, higher stone burden, long operation time, increased irrigation rate, and infectious stone composition are independent risk factors to predict urosepsis after one-phase PCNL. A nomogram based on perioperative clinical factors could be used to predict the risk of urosepsis.

Funding: none