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The association between renal pelvis urine density and the risk of severe infectious complications in patient with symptom-free hydronephrosis after shock wave lithotripsy: a multi-center prospective study

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Abstract

Finding reliable and easy-to-obtain predictors of severe infectious complications after shock wave lithotripsy (SWL) is a major clinical need, particular in symptom-free hydronephrosis. Therefore, we aim to prospectively investigate the predictive value of Hounsfield units (HU) in renal pelvis urine for the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL. This multi-center prospective study was conducted from June 2020 to December 2023. The HU of renal pelvis urine was measured by non-enhanced computed tomography. The severe infectious complications included systemic inflammatory response syndrome, sepsis, and septic shock. Binary logistic regression models assessed the odds ratios (ORs) and 95% confidence intervals (CIs). Finally, 1,436 patients with ureteral stones were enrolled in this study. 8.9% (128/1,436) of patients experienced severe infectious complications after SWL treatment. After adjusting confounding variables, compared with the patients in the lowest renal pelvis urine density quartile, the OR (95% CI) for the highest quartile was 32.36 (13.32, 78.60). There was a positive linear association between the HU value of renal pelvis urine and the risk of severe infectious complications after SWL (P for trend < 0.001). Furthermore, this association was also observed stratified by age, gender, BMI, stone size, stone location and hydronephrosis grade (all P for interaction > 0.05). Additionally, the nonlinear association employed by restricted cubic splines is not statistically significant (nonlinear P = 0.256). The AUROC and 95%CI of renal pelvis urine density were 0.895 (0.862 to 0.927, P value < 0.001). The cut-off value was 12.0 HU with 78.59% sensitivity and 85.94% specificity. This multi-center prospective study demonstrated a positive linear association between HU in renal pelvis urine and the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL, regardless of age, gender, BMI, stone size, stone location, and hydronephrosis grade. These findings might be helpful in the SWL treatment decision-making process.

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Acknowledgements

We give special thanks to all the colleagues at the Department of Urology of Shengjing Hospital for their help and support. We thank International Science Editing for editing this manuscript. The authors would like to thank all of the study participants.

Funding

This study was financially supported by Liaoning Provincial Science and Technology Plan Joint Program (Application Basic Research Project; 2023021056-JH2/1017). The 345 Talent Project of Shengjing Hospital (M0713). These sponsors had no role in the study design; in the collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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Author notes

  1. Dongmei Liu, Junlong Liu, and Zheming Li contribute equally to this work.

Authors and Affiliations

  1. Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People’s Republic of China

    Dongmei Liu, Junlong Liu, Zheming Li, Zhenhua Li & Song Bai

  2. The Fifth Hospital of Liaoyang City, Liaoyang, China

    Chengshan Ge & Hongqiang Guo

  3. Luhe Hospital of Yingkou City, Yingkou, China

    Shiyu Song

Authors
  1. Dongmei Liu
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  7. Zhenhua Li
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  8. Song Bai
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Contributions

Song Bai had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Song Bai: Protocol/project development. Dongmei Liu, Junlong Liu, Zheming Li, Chengshan Ge, Hongqiang Guo, Shiyu Song, Zhenhua Li, and Song Bai: Data collection or management. Dongmei Liu, Junlong Liu, Zheming Li, Chengshan Ge, Hongqiang Guo, and Shiyu Song: Data analysis. Dongmei Liu, Junlong Liu, and Zheming Li: Manuscript writing/editing.

Corresponding authors

Correspondence to Zhenhua Li or Song Bai.

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Conflict of interest

There is no conflict of interest. Song Bai declare that they have no competing interests.

Ethical approval

Ethical approval (2020PS521K) was provided by the Ethics Committee of Shengjing Hospital Affiliated China Medical University on 9 June 2020. Informed consent from all eligible subjects was obtained. The clinical research registry UIN is ChiCTR2000033789. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki.

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Liu, D., Liu, J., Li, Z. et al. The association between renal pelvis urine density and the risk of severe infectious complications in patient with symptom-free hydronephrosis after shock wave lithotripsy: a multi-center prospective study. Urolithiasis 52, 72 (2024). https://doi.org/10.1007/s00240-024-01572-5

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