Risk factors for sepsis in patients with struvite stones following percutaneous nephrolithotomy

  • Xiaomin Gao
  • Chaoyue Lu
  • Fei Xie
  • Ling Li
  • Min Liu
  • Ziyu Fang
  • Zeyu Wang
  • Shaoxiong Ming
  • Hao Dong
  • Rong Shen
  • Yinghao SunEmail author
  • Yonghan PengEmail author
  • Xiaofeng GaoEmail author
Original Article



To describe the clinical characteristics of struvite stones and determine the preoperative predictors of sepsis in struvite patients undergoing percutaneous nephrolithotomy (PCNL).


A retrospective study of patients who underwent PCNL between April 2011 and March 2018 was performed. The data of the struvite stones and non-struvite stones groups were compared following propensity score matching. Subsequently, the struvite stones group was sub-divided for further analysis according to the Sepsis-3 definition: non-sepsis and sepsis groups.


After matching based on age, gender, BMI, and number of access tracts, the comparative analysis showed that staghorn calculi and higher Guy’s stone score were more frequently observed in non-struvite stone patients (n = 97), while a history of urolithiasis surgery (56.70%), preoperative broad-spectrum antibiotic therapy (53.61%), positive preoperative urine culture (55.67%), and sepsis (35.05%) after surgery were more common in patients (n = 97) with struvite stones (all P values < 0.05). Eighteen (18.56%) patients presented with multidrug-resistant (MDR) bacteriuria. Multivariate analysis demonstrated that the preoperative presence of MDR bacteriuria (OR = 3.203; P = 0.043) and increased serum creatinine (OR = 3.963; P = 0.010) were independent risk predictors of sepsis. The two factors were used to construct a nomogram to predict the probability of sepsis. The nomogram was well calibrated and had moderate discriminative ability (concordance index: 0.711).


Our study revealed that patients with struvite stones were associated with a significantly high risk of calculi recurrence and sepsis after surgery. The presence of MDR bacteriuria preoperatively was a reliable factor to predict sepsis.


Percutaneous nephrolithotomy Struvite Renal calculi Multidrug resistant 



This study was supported by the National Natural Science Foundation of China (81670642, Xiaofeng Gao), 2017 Shanghai Outstanding Young Medical Talent training subsidy Scheme (second batch, Xiaofeng Gao), and National Key R&D Program of China (2017YFB1302800, Xiaofeng Gao).

Author contributions

GXM: manuscript writing, manuscript editing. LC and XF: data collection. LL, LM, FZ, and WZ: data collection and statistical analysis. MS, DH, and SR: manuscript editing. SY, PY, and GXF: project development, manuscript editing.


The authors declare that they have no relevant financial interest.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the local research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

For this retrospective study formal consent was not required.


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Copyright information

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

Authors and Affiliations

  • Xiaomin Gao
    • 1
  • Chaoyue Lu
    • 1
  • Fei Xie
    • 1
  • Ling Li
    • 1
  • Min Liu
    • 1
  • Ziyu Fang
    • 1
  • Zeyu Wang
    • 1
  • Shaoxiong Ming
    • 1
  • Hao Dong
    • 1
  • Rong Shen
    • 1
  • Yinghao Sun
    • 1
    Email author
  • Yonghan Peng
    • 1
    Email author
  • Xiaofeng Gao
    • 1
    Email author
  1. 1.Department of UrologyShanghai Changhai Hospital, Second Military Medical UniversityShanghaiChina

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