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Preoperative urine nitrite versus urine culture for predicting postoperative fever following flexible ureteroscopic lithotripsy: a propensity score matching analysis

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A Correction to this article was published on 15 September 2020

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Abstract

Purpose

Multiple studies have reported that preoperative positive urine culture is an independent risk factor for postoperative fever (POF) after ureteroscopy (URS). Urine nitrite is associated urinary tract infections (UTIs). However, none of studies has explored the role of urine nitrite in the prediction of POF after flexible URS (fURS).

Methods

Patients who underwent fURS by the same surgeon between 2009 and 2019 were screened. Sensitivity and specificity of urine culture and urine nitrite were calculated. Propensity score (PS) matching was performed to get a baseline-balanced retrospective cohort to avoid potential bias. Receiver operating characteristic-area under the curve (ROC-AUC) calculated was used to determine the predictive power of models. Decision curve analysis (DCA) was plotted to obtain the clinical benefit of the models.

Results

Poseoperative fever (POF) is defined as the temperature of the patient higher than 38 ℃ within 72 h after operation, with no sign of infection in other systems. 31(2.8%) of 1095 cases had POF after fURL. Urine nitrite had a better specificity than urine culture for POF diagnosis (P < 0.001). After the PS matching, a well-balanced cohort of 24 POF group and 96 no-POF group was produced. The mean AUC from the bootstrap resampling method for urine nitrite model (AUC: 0.8736; 95% CI: 0.8731–0.8743) was significantly increased than that of the urine culture model (AUC: 0.8385; 95% CI: 0.8378–0.8392). The application of two kinds of POF predicting models could bring clinical net benefit when the probability is < 35%. However, urine nitrite model showed a better clinical net benefit acquirement compared to the urine culture model.

Conclusion

Preoperative positive urine nitrite may play a pivotal role in the prediction of POF after fURS and needs to be validated by future evidence.

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References

  1. Scales CD Jr, Smith AC, Hanley JM, Saigal CS, Urologic Diseases in America P (2012) Prevalence of kidney stones in the United States. Eur Urol 62:160–165

    Article  Google Scholar 

  2. Saigal CS, Joyce G, Timilsina AR; Urologic Diseases in America P (2005) Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int 68:1808–1814

  3. Ordon M, Urbach D, Mamdani M, Saskin R, Dah RJ, Pace KT (2014) The surgical management of kidney stone disease: a population based time series analysis. J Urol 192:1450–1456

    Article  Google Scholar 

  4. Pradere B, Doizi S, Proietti S, Brachlow J, Traxer O (2018) Evaluation of guidelines for surgical management of urolithiasis. J Urol 199:1267–1271

    Article  Google Scholar 

  5. Bonkat G, Braissant O, Cai T, Koves B, Bjerklund Johansen TE, Pickard R et al (2017) Non-molecular methods to detect bacteriuria prior to urological interventions: a diagnostic accuracy systematic review. Eur Urol Focus 3:535–537

    Article  Google Scholar 

  6. Chu CM, Lowder JL (2018) Diagnosis and treatment of urinary tract infections across age groups. Am J Obstet Gynecol 219:40–51

    Article  Google Scholar 

  7. Sohn DW, Kim SW, Hong CG, Yoon BI, Ha US, Cho YH (2013) Risk factors of infectious complication after ureteroscopic procedures of the upper urinary tract. J Infect Chemother 19:1102–1108

    Article  Google Scholar 

  8. Mitsuzuka K, Nakano O, Takahashi N, Satoh M (2016) Identification of factors associated with postoperative febrile urinary tract infection after ureteroscopy for urinary stones. Urolithiasis 44:257–262

    Article  Google Scholar 

  9. Southern JB, Higgins AM, Young AJ, Kost KA, Schreiter BR, Clifton M et al (2019) Risk factors for postoperative fever and systemic inflammatory response syndrome after ureteroscopy for stone disease. J Endourol 33:516–522

    Article  Google Scholar 

  10. Senocak C, Ozcan C, Sahin T, Yilmaz G, Ozyuvali E, Sarikaya S et al (2018) Risk factors of infectious complications after flexible uretero-renoscopy with laser lithotripsy. Urol J 15:158–163

    PubMed  Google Scholar 

  11. Coulthard MG (2019) Using urine nitrite sticks to test for urinary tract infection in children aged %3c 2 years: a meta-analysis. Pediatr Nephrol 34:1283–1288

    Article  Google Scholar 

  12. Ginting F, Sugianli AK, Kusumawati RL, Parwati I, de Jong MD, Schultsz C et al (2018) Predictive value of the urinary dipstick test in the management of patients with urinary tract infection-associated symptoms in primary care in Indonesia: a cross-sectional study. BMJ Open 8:e023051

    Article  Google Scholar 

  13. Chao MR, Shih YM, Hsu YW, Liu HH, Chang YJ, Lin BH et al (2016) Urinary nitrite/nitrate ratio measured by isotope-dilution LC-MS/MS as a tool to screen for urinary tract infections. Free Radic Biol Med 93:77–83

    Article  CAS  Google Scholar 

  14. Lundberg JO, Carlsson S, Engstrand L, Morcos E, Wiklund NP, Weitzberg E (1997) Urinary nitrite: more than a marker of infection. Urology 50:189–191

    Article  CAS  Google Scholar 

  15. D'Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17:2265–2281

    Article  Google Scholar 

  16. Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70:41–55

    Article  Google Scholar 

  17. Li T, Sun XZ, Lai DH, Li X, He YZ (2018) Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: risk factors and predictive model. Kaohsiung J Med Sci 34:400–408

    Article  Google Scholar 

  18. Baseskioglu B (2019) The Prevalence of Urinary Tract Infection Following Flexible Ureterenoscopy and The Associated Risk Factors. Urol J 16:1735–1746

    Google Scholar 

  19. Uchida Y, Takazawa R, Kitayama S, Tsujii T (2018) Predictive risk factors for systemic inflammatory response syndrome following ureteroscopic laser lithotripsy. Urolithiasis 46:375–381

    Article  Google Scholar 

  20. Tabei T, Ito H, Usui K, Kuroda S, Kawahara T, Terao H et al (2016) Risk factors of systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position. Int J Urol 23:687–692

    Article  Google Scholar 

  21. Blackmur JP, Maitra NU, Marri RR, Housami F, Malki M, McIlhenny C (2016) Analysis of factors' association with risk of postoperative urosepsis in patients undergoing ureteroscopy for treatment of stone disease. J Endourol 30:963–969

    Article  Google Scholar 

  22. Zhong W, Leto G, Wang L, Zeng G (2015) Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol 29:25–28

    Article  Google Scholar 

  23. Chen Y, Liao B, Feng S, Ye D, Zeng G, Wang K et al (2018) Comparison of safety and efficacy in preventing postoperative infectious complications of a 14/16F ureteral access sheath with a 12/14F ureteral access sheath in flexible ureteroscopic lithotripsy. J Endourol 32:923–927

    Article  Google Scholar 

  24. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46:399–424

    Article  Google Scholar 

  25. Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34:3661–3679

    Article  Google Scholar 

  26. De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R et al (2015) Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol 67:125–137

    Article  Google Scholar 

  27. Austin PC, Grootendorst P, Anderson GM (2007) A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Stat Med 26:734–753

    Article  Google Scholar 

  28. Austin PC (2011) A tutorial and case study in propensity score analysis: an application to estimating the effect of in-hospital smoking cessation counseling on mortality. Multivar Behav Res 46:119–151

    Article  Google Scholar 

  29. James GP, Paul KL, Fuller JB (1978) Urinary nitrite and urinary-tract infection. Am J Clin Pathol 70:671–678

    Article  CAS  Google Scholar 

  30. Carlos EC, Youssef RF, Kaplan AG, Wollin DA, Winship BB, Eisner BH et al (2018) Antibiotic utilization before endourological surgery for urolithiasis: endourological society survey results. J Endourol 32:978–985

    Article  Google Scholar 

  31. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al (2016) Surgical management of stones: American Urological Association/Endourological Society guideline, Part I. J Urol 196:1153–1160

    Article  Google Scholar 

  32. Aragon IM, Herrera-Imbroda B, Queipo-Ortuno MI, Castillo E, Del Moral JS, Gomez-Millan J et al (2018) The urinary tract microbiome in health and disease. Eur Urol Focus 4:128–138

    Article  Google Scholar 

  33. Whiteside SA, Razvi H, Dave S, Reid G, Burton JP (2015) The microbiome of the urinary tract–a role beyond infection. Nat Rev Urol 12:81–90

    Article  Google Scholar 

  34. Barr-Beare E, Saxena V, Hilt EE, Thomas-White K, Schober M, Li B et al (2015) The interaction between Enterobacteriaceae and calcium oxalate deposits. PLoS ONE 10:e0139575

    Article  Google Scholar 

  35. Noiphung J, Laiwattanapaisal W (2019) Multifunctional paper-based analytical device for in situ cultivation and screening of Escherichia coli infections. Sci Rep 9:1555

    Article  Google Scholar 

  36. Kajander EO, Ciftcioglu N, Aho K, Garcia-Cuerpo E (2003) Characteristics of nanobacteria and their possible role in stone formation. Urol Res 31:47–54

    Article  Google Scholar 

  37. Grine G, Lotte R, Chirio D, Chevalier A, Raoult D, Drancourt M et al (2019) Co-culture of Methanobrevibacter smithii with enterobacteria during urinary infection. EBioMedicine 43:333–337

    Article  Google Scholar 

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Acknowledgements

We sincerely thank engineer Ran Liu from Engineering Research Center of Medical Information Technology Ministry of Education for providing clinical data sorting support for this study.

Funding

This article was supported by grants fromThe National Natural Science Fund of China, Identify the key intestinal flora regulation protein to oxalate metabolism and calcium oxalate kidney stone formation with metaproteomics strategy (81770703), Project of Science and Technology Department of Sichuan Province (2018SZ0118), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYGD18011 and ZYJC18015).

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Author notes

  1. Yu-cheng Ma and Zhong-Yu Jian contributed equally to this work and should be considered as co-first author.

Authors and Affiliations

  1. Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People’s Republic of China

    Yu-cheng Ma, Zhong-Yu Jian, Hong Li & Kun-Jie Wang

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  1. Yu-cheng Ma
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  2. Zhong-Yu Jian
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Contributions

YM: project development, data collection, data analysis, manuscript writing. Z-YJ: project development, data collection, data analysis, manuscript writing. HL: project development, critical revision of the article. K-JW: project development, critical revision of the article.

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Correspondence to Kun-Jie Wang.

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The authors of this article as well as all the included studies declare that they have no conflict of interest.

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The study protocol is compliant with ethical standards and approved by the local ethics committee (West China Hospital, Sichuan University).

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Ma, Yc., Jian, ZY., Li, H. et al. Preoperative urine nitrite versus urine culture for predicting postoperative fever following flexible ureteroscopic lithotripsy: a propensity score matching analysis. World J Urol 39, 897–905 (2021). https://doi.org/10.1007/s00345-020-03240-w

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