Advertisement

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
  • 27 Downloads

Abstract

Purpose

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

Methods

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.

Results

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).

Conclusion

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.

Keywords

Percutaneous nephrolithotomy Struvite Renal calculi Multidrug resistant 

Notes

Acknowledgements

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.

Funding

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.

References

  1. 1.
    Flannigan R, Choy WH, Chew B, Lange D (2014) Renal struvite stones—pathogenesis, microbiology, and management strategies. Nat Rev Urol 11(6):333–341.  https://doi.org/10.1038/nrurol.2014.99 CrossRefGoogle Scholar
  2. 2.
    McAleer IM, Kaplan GW, Bradley JS, Carroll SF, Griffith DP (2003) Endotoxin content in renal calculi. J Urol 169(5):1813–1814.  https://doi.org/10.1097/01.ju.0000061965.51478.79 CrossRefGoogle Scholar
  3. 3.
    Shafi H, Shahandeh Z, Heidari B, Sedigiani F, Ramaji AA, Pasha YR, Kassaeian AA, Pasha AA, Mir MM (2013) Bacteriological study and structural composition of staghorn stones removed by the anatrophic nephrolithotomic procedure. Saudi J Kidney Dis Transplant 24(2):418–423CrossRefGoogle Scholar
  4. 4.
    Rivera M, Viers B, Cockerill P, Agarwal D, Mehta R, Krambeck A (2016) Pre- and postoperative predictors of infection-related complications in patients undergoing percutaneous nephrolithotomy. J Endourol 30(9):982–986.  https://doi.org/10.1089/end.2016.0191 CrossRefGoogle Scholar
  5. 5.
    Olvera-Posada D, Ali SN, Dion M, Alenezi H, Denstedt JD, Razvi H (2016) Natural history of residual fragments after percutaneous nephrolithotomy: evaluation of factors related to clinical events and intervention. Urology 97:46–50.  https://doi.org/10.1016/j.urology.2016.06.049 CrossRefGoogle Scholar
  6. 6.
    Zhong W, Leto G, Wang L, Zeng G (2015) Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol 29(1):25–28.  https://doi.org/10.1089/end.2014.0409 CrossRefGoogle Scholar
  7. 7.
    Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J (1991) Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol 146(4):955–960CrossRefGoogle Scholar
  8. 8.
    O’Keeffe NK, Mortimer AJ, Sambrook PA, Rao PN (1993) Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol 72(3):277–283CrossRefGoogle Scholar
  9. 9.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810.  https://doi.org/10.1001/jama.2016.0287 CrossRefGoogle Scholar
  10. 10.
    Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18(3):268–281.  https://doi.org/10.1111/j.1469-0691.2011.03570.x CrossRefGoogle Scholar
  11. 11.
    Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15(4):361–387.  https://doi.org/10.1002/(sici)1097-0258(19960229)15:4%3c361:aid-sim168%3e3.0.co;2-4 CrossRefGoogle Scholar
  12. 12.
    Huitzil-Melendez FD, Capanu M, O’Reilly EM, Duffy A, Gansukh B, Saltz LL, Abou-Alfa GK (2010) Advanced hepatocellular carcinoma: which staging systems best predict prognosis? J Clin Oncol 28(17):2889–2895.  https://doi.org/10.1200/jco.2009.25.9895 CrossRefGoogle Scholar
  13. 13.
    Troxel SA, Low RK (2002) Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever. J Urol 168(4 Pt 1):1348–1351.  https://doi.org/10.1097/01.ju.0000030996.64339.f1 CrossRefGoogle Scholar
  14. 14.
    Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, Iwashyna TJ (2014) Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 312(1):90–92.  https://doi.org/10.1001/jama.2014.5804 CrossRefGoogle Scholar
  15. 15.
    Kwan A, Hubank M, Rashid A, Klein N, Peters MJ (2013) Transcriptional instability during evolving sepsis may limit biomarker based risk stratification. PLoS One 8(3):e60501.  https://doi.org/10.1371/journal.pone.0060501 CrossRefGoogle Scholar
  16. 16.
    Churpek MM, Zadravecz FJ, Winslow C, Howell MD, Edelson DP (2015) Incidence and prognostic value of the systemic inflammatory response syndrome and organ dysfunctions in ward patients. Am J Respir Crit Care Med 192(8):958–964.  https://doi.org/10.1164/rccm.201502-0275OC CrossRefGoogle Scholar
  17. 17.
    Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R (2015) Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med 372(17):1629–1638.  https://doi.org/10.1056/NEJMoa1415236 CrossRefGoogle Scholar
  18. 18.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international Sepsis definitions conference. Intensive Care Med 29(4):530–538.  https://doi.org/10.1007/s00134-003-1662-x CrossRefGoogle Scholar
  19. 19.
    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein 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(6):1644–1655CrossRefGoogle Scholar
  20. 20.
    Nemoy NJ, Staney TA (1971) Surgical, bacteriological, and biochemical management of “infection stones”. JAMA 215(9):1470–1476CrossRefGoogle Scholar
  21. 21.
    Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302(21):2323–2329.  https://doi.org/10.1001/jama.2009.1754 CrossRefGoogle Scholar
  22. 22.
    Centers for disease control and prevention (2018). Biggest threats and data. Available from: https://www.cdc.gov/drugresistance/biggest_threats.html. Accessed 1 Jan 2019
  23. 23.
    Vardakas KZ, Rafailidis PI, Konstantelias AA, Falagas ME (2013) Predictors of mortality in patients with infections due to multi-drug resistant gram negative bacteria: the study, the patient, the bug or the drug? J Infect 66(5):401–414.  https://doi.org/10.1016/j.jinf.2012.10.028 CrossRefGoogle Scholar
  24. 24.
    Patel N, Shi W, Liss M, Raheem O, Wenzler D, Schallhorn C, Kiyama L, Lakin C, Ritter M, Sur RL (2015) Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol 29(5):531–536.  https://doi.org/10.1089/end.2014.0776 CrossRefGoogle Scholar
  25. 25.
    Kaye KS, Pogue JM (2015) Infections caused by resistant gram-negative bacteria: epidemiology and management. Pharmacotherapy 35(10):949–962.  https://doi.org/10.1002/phar.1636 CrossRefGoogle Scholar
  26. 26.
    Chen D, Jiang C, Liang X, Zhong F, Huang J, Lin Y, Zhao Z (2018) Early and rapid prediction of postoperative infections following percutaneous nephrolithotomy in patients with complex kidney stones. BJU Int.  https://doi.org/10.1111/bju.14484 Google Scholar
  27. 27.
    Sen V, Bozkurt IH, Aydogdu O, Yonguc T, Yarimoglu S, Sen P, Koras O, Degirmenci T (2016) Significance of preoperative neutrophil–lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy. The Kaohsiung J Med Sci 32(10):507–513.  https://doi.org/10.1016/j.kjms.2016.08.008 CrossRefGoogle Scholar
  28. 28.
    Zahorec R (2001) Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 102(1):5–14Google Scholar
  29. 29.
    Mostafavi MR, Ernst RD, Saltzman B (1998) Accurate determination of chemical composition of urinary calculi by spiral computerized tomography. J Urol 159(3):673–675CrossRefGoogle Scholar

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

Personalised recommendations