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A preliminary study: the role of preoperative procalcitonin in predicting postoperative fever after mini-percutaneous nephrolithotomy in patients with a negative baseline urine culture

  • Deng Li
  • Minglei Sha
  • Lei Chen
  • Yinglong Xiao
  • Jun Lu
  • Yi ShaoEmail author
Original Paper

Abstract

To evaluate the role of preoperative procalcitonin (PCT) levels in predicting postoperative fever after mini-percutaneous nephrolithotomy (mini-PCNL) in patients with a negative baseline urine culture. Between January 2014 and October 2017, 329 patients with a negative baseline urine culture and who underwent mini-PCNL were enrolled in this study. Patients were stratified into the control or febrile group based on a body temperature either less than or greater than 38 °C, respectively. Demographic and perioperative data were compared between the groups, and variables found to be statistically significant were included in a binary logistic regression analysis. A total of 68 (20.6%) patients experienced postoperative fever. The univariate analysis revealed a statistically significant difference between groups in preoperative fever (p = 0.032), stone burden (p < 0.001), C-reactive protein (p = 0.011), PCT (p < 0.001) and interleukin-6 (p = 0.035) levels. Binary logistic regression analysis indicated that stone burden > 353 mm3 (p = 0.003) and PCT > 0.05 ng/mL (p < 0.001) are independent risk factors for postoperative fever in mini-PCNL-treated patients with a negative baseline urine culture. We concluded that patients with stone burden > 353 mm3 or PCT > 0.05 ng/mL were more likely to develop postoperative fever after mini-PCNL, though with a negative baseline urine culture.

Keywords

Percutaneous nephrolithotomy Postoperative fever Risk factors Procalcitonin 

Notes

Funding

This study was funded by the National Natural Science Foundation of China (Grant 81200504).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51:899–906CrossRefGoogle Scholar
  2. 2.
    Viers BR, Cockerill PA, Mehta RA, Bergstralh EJ, Krambeck AE (2014) Extended antimicrobial use in patients undergoing percutaneous nephrolithotomy and associated antibiotic related complications. J Urol 192:1667–1672CrossRefGoogle Scholar
  3. 3.
    Wagenlehner FM, Lichtenstern C, Rolfes C, Mayer K, Uhle F, Weidner W, Weigand MA (2013) Diagnosis and management for urosepsis. Int J Urol 20:963–970Google Scholar
  4. 4.
    Pierrakos C, Vincent JL (2010) Sepsis biomarkers: a review. Crit Care 14:R15CrossRefGoogle Scholar
  5. 5.
    Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173:1610–1614CrossRefGoogle Scholar
  6. 6.
    Knudsen JB, Fuursted K, Petersen E, Wierup P, Mølgaard H, Poulsen SH, Egeblad H (2010) Procalcitonin in 759 patients clinically suspected of infective endocarditis. Am J Med 123:1121–1127CrossRefGoogle Scholar
  7. 7.
    Müller F, Christ-Crain M, Bregenzer T, Krause M, Zimmerli W, Mueller B, Schuetz P, ProHOSP Study Group (2010) Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial. Chest 138:121–129CrossRefGoogle Scholar
  8. 8.
    van Nieuwkoop C, Bonten TN, van’t Wout JW, Kuijper EJ, Groeneveld GH, Becker MJ, Koster T, Wattel-Louis GH, Delfos NM, Ablij HC, Leyten EM, van Dissel JT (2010) Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study. Crit Care 14:R206CrossRefGoogle Scholar
  9. 9.
    Druskin SC, Ziemba JB (2016) Minimally invasive (“Mini”) percutaneous nephrolithotomy: classification, indications, and outcomes. Curr Urol Rep 17:30CrossRefGoogle Scholar
  10. 10.
    Procalcitonin Emergency Clinical Application of Expert Consensus Group (2012) Expert consensus on clinical application of procalcitonin (PCT) in emergency. Chin J Emerg Med 9:944–951Google Scholar
  11. 11.
    Tiselius HG, Andersson A (2003) Stone burden in an average Swedish population of stone formers requiring active stone removal: how can the stone size be estimated in the clinical routine? Eur Urol 43:275–281CrossRefGoogle Scholar
  12. 12.
    Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, Grabe M, Rosette On Behalf Of The Croes Pcnl Study Group J (2011) The percutaneous nephrolithotomy global study: classification of complications. J Endourol 25:1275–1280CrossRefGoogle Scholar
  13. 13.
    Gravas S, Montanari E, Geavlete P, Onal B, Skolarikos A, Pearle M, Sun YH, de la Rosette J (2012) Postoperative infection rates in low risk patients undergoing percutaneous nephrolithotomy with and without antibiotic prophylaxis: a matched case control study. J Urol 188:843–847CrossRefGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  15. 15.
    Zeng G, Mai Z, Zhao Z, Li X, Zhong W, Yuan J, Wu K, Wu W (2013) Treatment of upper urinary calculi with Chinese minimally invasive percutaneous nephrolithotomy: a single-center experience with 12,482 consecutive patients over 20 years. Urolithiasis 41:225–229CrossRefGoogle Scholar
  16. 16.
    Kreydin EI, Eisner BH (2013) Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 10:598–605CrossRefGoogle Scholar
  17. 17.
    Fowler JE Jr (1984) Bacteriology of branched renal calculi and accompanying urinary tract infection. J Urol 131:213–215CrossRefGoogle Scholar
  18. 18.
    Sridharan P, Chamberlain RS (2013) The efficacy of procalcitonin as a biomarker in the management of sepsis: slaying dragons or tilting at windmills? Surg Infect (Larchmt) 14:489–511CrossRefGoogle Scholar
  19. 19.
    Bozza FA, Bozza PT, Castro Faria Neto HC (2005) Beyond sepsis pathophysiology with cytokines: what is their value as biomarkers for disease severity? Mem Inst Oswaldo Cruz 100(Suppl 1):217–221CrossRefGoogle Scholar
  20. 20.
    Liu HH, Guo JB, Geng Y, Su L (2015) Procalcitonin: present and future. Ir J Med Sci 184:597–605CrossRefGoogle Scholar
  21. 21.
    Anand D, Das S, Bhargava S, Srivastava LM, Garg A, Tyagi N, Taneja S, Ray S (2015) Procalcitonin as a rapid diagnostic biomarker to differentiate between culture-negative bacterial sepsis and systemic inflammatory response syndrome: a prospective, observational, cohort study. J Crit Care 30:218.e7–218.e12CrossRefGoogle Scholar
  22. 22.
    Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, Müller B (2004) Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Crit Care Med 32:1715–1721CrossRefGoogle Scholar
  23. 23.
    Gonsalves MD, Sakr Y (2010) Early identification of sepsis. Curr Infect Dis Rep 12:329–335CrossRefGoogle Scholar
  24. 24.
    Zheng J, Li Q, Fu W, Ren J, Song S, Deng G, Yao J, Wang Y, Li W, Yan J (2015) Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy. Urolithiasis 43:41–47CrossRefGoogle Scholar
  25. 25.
    Pantelidou IM, Giamarellos-Bourboulis EJ (2015) Can procalcitonin monitoring reduce the length of antibiotic treatment in bloodstream infections? Int J Antimicrob Agents 46(Suppl 1):S10–S12CrossRefGoogle Scholar
  26. 26.
    Dreger NM, Degener S, Ahmad-Nejad P, Wöbker G, Roth S (2015) Urosepsis-etiology, diagnosis, and treatment. Dtsch Arztebl Int 112:837–847Google Scholar
  27. 27.
    Griffith DP (1979) Urease stones. Urol Res 7:215–221CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Deng Li
    • 1
  • Minglei Sha
    • 2
  • Lei Chen
    • 1
  • Yinglong Xiao
    • 3
  • Jun Lu
    • 1
  • Yi Shao
    • 1
    Email author
  1. 1.Department of Urology, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Department of Gerontology, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China
  3. 3.Department of Urology, Shanghai General HospitalNanjing Medical UniversityShanghaiPeople’s Republic of China

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