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Predictors for uroseptic shock in patients who undergo minimally invasive percutaneous nephrolithotomy

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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.

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Authors and Affiliations

  1. Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

    Junhong Fan, Shawpong Wan, Luhao Liu, Zhijian Zhao, Zanlin Mai, Dong Chen, Wei Zhu, Zhou Yang, Lili Ou & Wenqi Wu

  2. Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China

    Junhong Fan, Shawpong Wan, Luhao Liu, Zhijian Zhao, Zanlin Mai, Dong Chen, Wei Zhu, Zhou Yang, Lili Ou & Wenqi Wu

Authors
  1. Junhong Fan
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  2. Shawpong Wan
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  3. Luhao Liu
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  4. Zhijian Zhao
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  5. Zanlin Mai
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  6. Dong Chen
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  7. Wei Zhu
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  8. Zhou Yang
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  9. Lili Ou
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  10. Wenqi Wu
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Correspondence to Wenqi Wu.

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Fan, J., Wan, S., Liu, L. et al. Predictors for uroseptic shock in patients who undergo minimally invasive percutaneous nephrolithotomy. Urolithiasis 45, 573–578 (2017). https://doi.org/10.1007/s00240-017-0963-4

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  • DOI: https://doi.org/10.1007/s00240-017-0963-4

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