Predictive risk factors for systemic inflammatory response syndrome following ureteroscopic laser lithotripsy
- 162 Downloads
The objective of this study was to investigate risk factors for the development of systemic inflammatory response syndrome following ureteroscopic laser lithotripsy. We retrospectively collected data of 469 patients who underwent ureteroscopic laser lithotripsy at our single institution from February 2008 to June 2016. Details for the patient, the stone, and the surgical factors that potentially contributed to postoperative infection were extracted. Using a logistic regression model, we analyzed how the clinical factors affected the incidence of systemic inflammatory response syndrome. Twenty-seven patients (5.7%) were postoperatively diagnosed with systemic inflammatory response syndrome; of these, 25 patients were diagnosed within 24 h after ureteroscopy. One patient required intensive care unit admission, but no death was reported. A preoperative stent was significantly associated with postoperative systemic inflammatory response syndrome only on univariate analysis, and the reasons for stenting were varied. Multivariate analysis revealed that obstructive pyelonephritis, a positive preoperative bladder urine culture result, and female gender were significantly associated with postoperative systemic inflammatory response syndrome. Patients who experienced obstructive pyelonephritis preceding ureteroscopic laser lithotripsy or had a positive preoperative bladder urine culture result were at an increased risk of systemic inflammatory response syndrome despite receiving appropriate preoperative antibiotic therapy. Regarding the impact of a preoperative stent on postoperative infection, further investigation focusing on reasons for stenting is needed.
KeywordsLithotripsy Obstructive pyelonephritis Risk factor Systemic inflammatory response syndrome Ureteral stent Ureteroscopy
Authors’ contribution statement
Uchida: project development, data collection, data analysis, and manuscript writing. Takazawa: project development, data collection, and manuscript editing. Kitayama: data collection. Tsujii: supervision
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional research committee and with 1964 Helsinki declaration and its later amendments or comparable ethical standards. The institutional review board approved protocol number is 2016-42. For this type of study, formal consent is not required.
- 9.Bone RC, Balk RA, Cerra FB, Dellinger RP, Ferin AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655CrossRefPubMedGoogle Scholar
- 17.Martov A, Gravas S, Etemadian M, Unsal A, Barusso G, D’Addessi A, Krambeck A, de la Rosette J, Clinical Research Office of the Endourological Society Ureteroscopy Study Group (2015) Postoperative infection rates in patients with a negative baseline urine culture undergoing ureteroscopic stone removal: a matched case-control analysis on antibiotic prophylaxis from the CROES URS global study. J Endourol 29:171–180CrossRefPubMedGoogle Scholar
- 19.Youssef RF, Neisius A, Goldsmith ZG, Ghaffar M, Tsivian M, Shin RM, Cabrera F, Ferrandino MN, Scales CD, Preminger GM, Lipkin ME (2014) Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis: matched pair comparison with elective ureteroscopy. J Endourol 28:1439–1443CrossRefPubMedGoogle Scholar