title: Predictors of systemic inflammatory response syndrome following percutaneous nephrolithotomy.
abstract: OBJECTIVE
  Sepsis remains one of the dreaded complications of percutaneous nephrolithotomy (PCNL). To analyze prospectively the preoperative and intraoperative factors that predict the occurrence of systemic inflammatory response syndrome (SIRS) in patients undergoing PCNL so that we can aggressively manage those patients from the preoperative period itself and avert the dangerous complications.
  
  
  METHODS
  A prospective study was carried out between August 2012 and March 2013 including all patients who underwent PCNL. Patients with infected collecting system, synchronous ureteric stones, stents, or percutaneous nephrostomy drainage were excluded from the study. Patients were evaluated with physical examination, urine analysis, urine culture and sensitivity, complete blood count, renal function test, X-ray kidney, ureter, and bladder (KUB), and plain and contrast-enhanced computerized tomography KUB. Patients who developed any two or above of the following in the postoperative period were considered to have developed SIRS. (1) Temperature >100.4°F (38°C) or <96.8°F (36°C). (2) Pulse rate >90/min. (3) Respiratory rate >20/min. (4) White blood cell count >12,000/ml or <4000/ml.
  
  
  RESULTS
  Of the 120 patients who underwent PCNL 29 (24.1%) developed features of SIRS. On univariate analysis, gender, diabetes mellitus, bladder urine culture, and serum creatinine were found to be statistically insignificant. Blood transfusion (P= 0.009), no of access tracts (P= 0.001), pelvic urine culture (P= 0.04), stone culture (P= 0.003), stone size (P= 0.001), age (P= 0.019), and operative time (P= 0.004) were found to be statistically significant. On multivariate regression analysis stone size, no of access tracts, operative time, and stone culture were found to be statistically significant with regard to the occurrence of SIRS.
  
  
  CONCLUSIONS
  Patients with above-identified risk factors must be aggressively treated to prevent the occurrence of sepsis postoperatively.
authors.affiliation: Department of Urology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Karunamoorthy
authors.initials: K
authors.lastname: Ramaraju
authors.affiliation: Department of Urology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Arun Kumar
authors.initials: AK
authors.lastname: Paranjothi
authors.affiliation: Department of Urology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Dhinakar Babu
authors.initials: DB
authors.lastname: Namperumalsamy
authors.affiliation: Department of Urology, Madras Medical College, Chennai, Tamil Nadu, India.
authors.forename: Ilamparuthi
authors.initials: I
authors.lastname: Chennakrishnan
keywords: Percutaneous nephrolithotomy; post PCNL complications; systemic inflammatory response syndrome