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Performance of SOFA, qSOFA and SIRS to predict septic shock after percutaneous nephrolithotomy

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Abstract

Objective

The new clinical criteria termed SOFA and qSOFA were demonstrated to be more accurate than SIRS in screening patients at high risk of sepsis. We aim to evaluate the ability of SOFA, qSOFA and SIRS to predict septic shock after PCNL.

Patients and methods

Consecutive patients undergoing PCNL were included to assess the performance of SOFA, qSOFA and SIRS in predicting septic shock, the AUC of ROC curve and decision curve analysis were used, and the optimal cutoff values and their achieving time were calculated.

Results

Of the 431 included patients, 12 (2.7%) cases developed septic shock. Compared with non-septic shock patients, patients with septic shock were more likely to be female, have positive history of urine culture and higher urine leukocyte count, and show increased postoperative serum creatinine, PCT and decreased leukocyte. The optimal cutoff of SOFA, qSOFA and SIRS was > 2, > 0 and > 1, respectively. All of the 12 patients with verified septic shock met SOFA and SIRS criteria, while only 11 cases met qSOFA criterion. SOFA had the identical highest sensitivity (100%) and greater specificity (87% vs. 81%) than SIRS. qSOFA had higher specificity (92%) than both SOFA and SIRS at the expense of lower sensitivity (92%). The AUC of SOFA (0.973) to predict septic shock was greater than that of qSOFA (0.928) and SIRS (0.935). When combined with SIRS, SOFA outperformed qSOFA for discrimination of septic shock (AUC 0.987 vs. 0.978). Decision curve analysis indicated SOFA was clearly superior to both qSOFA and SIRS with a higher net benefit and net reduction in intervention. The qSOFA achieved the best time-based predictive efficiency, with the shortest median time to meet its cutoff, followed by SOFA and SIRS.

Conclusion

The performance of SOFA in predicting septic shock after PCNL was slightly greater than qSOFA and SIRS. The comprehensive application of various criteria is recommended to assist early detection of septic shock following PCNL.

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Acknowledgements

This work was sponsored by National Natural Science Foundation of China (81670642, Xiaofeng Gao), Shanghai Science and Technology Support Project in Biomedicine (17441900800, Yonghan Peng), and Shanghai Sailing Program (18YF1422600, Wei Zhang).

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Author notes

  1. Yonghan Peng, Wei Zhang and Yalong Xu These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China

    Yonghan Peng, Wei Zhang, Yalong Xu, Ling Li, Shaoxiong Ming, Ziyu Fang, Zeyu Wang & Xiaofeng Gao

  2. Department of Urology, Shaoxing Shangyu People’s Hospital, Shaoxing, 312300, Zhejiang, China

    Weixing Yu

  3. Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, 511518, Guangdong, China

    Jianwen Zeng

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Contributions

PYH: manuscript writing, manuscript editing. ZW and XY: data collection and statistical analysis. LL, YW, and ZJ: data collection. MS, FZ, and WZ: manuscript editing. GXF: project development, manuscript editing.

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Correspondence to Xiaofeng Gao.

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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.

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Peng, Y., Zhang, W., Xu, Y. et al. Performance of SOFA, qSOFA and SIRS to predict septic shock after percutaneous nephrolithotomy. World J Urol 39, 501–510 (2021). https://doi.org/10.1007/s00345-020-03183-2

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