title: Predictors for uroseptic shock in patients who undergo minimally invasive percutaneous nephrolithotomy.
abstract: To identify risk factors that can predict which patient is likely to progress from systemic inflammatory response syndrome (SIRS) to uroseptic shock after minimally invasive percutaneous nephrolithotomy (MPCNL) for the upper urinary tract stones. We retrospectively reviewed 156 patients who suffered infectious complications after MPCNL from March 2014 to February 2016. Perioperative risk factors that could potentially contribute to uroseptic shock were compared to those of patients with only SIRS. 135 of the 156 patients developed to SIRS only, the remaining 21 patients progressed to uroseptic shock. The rate of positive preoperative urine nitrite was significantly higher (p < 0.001), stone diameter was larger (p = 0.015) and operative time was longer (p < 0.001) in uroseptic shock group. Multivariable logistic analysis showed that preoperative urine nitrite (OR 10.570, p = 0.025), stone size (OR 11.512, p = 0.009) and postoperative blood leukopenia (OR 0.009, p < 0.001) were independently related to uroseptic shock. Moreover, ROC curve analysis showed that white blood count threshold within the first 3 h of uroseptic shock was 2.98 × 109/L. The sensitivity and specificity of leukocyte count in predicting uroseptic shock were 90.5 and 92.6%, respectively. Preoperative urine nitrite, stone size and postoperative leukocyte count are statistically linked to uroseptic shock after MPCNL. Leukopenia of less than 2.98 × 109/L within 3 h after MPCNL can be a predictor for uroseptic shock. For patients who have high risk factors for developing uroseptic shock, the white blood count should be measured within 3 h after MPCNL.
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Junhong
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Shawpong
authors.initials: S
authors.lastname: Wan
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Luhao
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Zhijian
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Zanlin
authors.initials: Z
authors.lastname: Mai
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Ou
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. wwqwml@163.com.|Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China. wwqwml@163.com.
authors.forename: Wenqi
authors.initials: W
authors.lastname: Wu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy* / Q000652:urine; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D000074642:Nephrolithotomy, Percutaneous / Q000009:adverse effects*; D009573:Nitrites / Q000652:urine; D061646:Operative Time; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology* / Q000652:urine; D057234:Preoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012772:Shock, Septic / Q000097:blood / Q000209:etiology* / Q000652:urine; D013997:Time Factors; D014552:Urinary Tract Infections / Q000097:blood / Q000209:etiology* / Q000652:urine
chemical_list: D009573:Nitrites
keywords: Leukocyte count; Minimally invasive percutaneous nephrolithotomy; Systemic inflammatory response syndrome; Urolithiasis; Uroseptic shock