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The value of procalcitonin for predicting urosepsis after mini-percutaneous nephrolithotomy or flexible ureteroscopy based on different organisms

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A Correction to this article was published on 01 November 2021

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Abstract

Purpose

To assess the value of procalcitonin (PCT) as an early biomarker for predicting urosepsis caused by Gram-negative (GN) bacteria, Gram-positive (GP) bacteria and fungi following mini-percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy (FURS).

Methods

A total number of 356 patients with positive preoperative UC (urine cultures) who underwent mPCNL and FURS between June 2017 and January 2021 were retrospectively analyzed. Univariable analysis and multivariable logistic regression analysis were conducted to compare the predictors for urosepsis caused by different organisms. Furthermore, the nomogram was established as a predicted model for urosepsis.

Results

Among 356 positive UC, 265 (74.4%) were positive for GN bacteria, 77 (21.4%) for GP bacteria and 14 (3.9%) for fungal pathogens. Escherichia coli (48.9%) were the predominant pathogens and Enterococcus (54/77) were the most common GP bacteria. Multivariate logistic regression analysis showed that positive nitrite (OR 3.31, 95% CI 1.20–9.14; P = 0.021), operative time > 90 min (OR 3.10, 95% CI 1.10–8.75, P = 0.033) and postoperative PCT > 0.1 ng/mL (OR 56.18, 95% CI 15.20–207.64, P < 0.001) were associated with postoperative urosepsis originated in GN infections, while urosepsis caused by GP bacteria and fungi was not associated with PCT > 0.1 ng/mL (P = 0.198), only stone burden > 800 mm2 (OR 3.69, 95% CI 1.01–13.53, P = 0.049) was an independent risk factor.

Conclusions

For patients with positive preoperative UC, postoperative PCT > 0.1 ng/mL was an independent risk factor of post-PCNL and post-FURS urosepsis caused by GN bacteria rather than GP bacteria and fungi.

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Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Change history

Abbreviations

GN:

Gram negative

GP:

Gram positive

mPCNL:

Mini-percutaneous nephrolithotomy

FURS:

Flexible ureteroscopy

UC:

Urine culture

BMI:

Body mass index

PCT:

Procalcitonin

CRP:

C-reactive protein

MPV:

Mean platelet volume

NLR:

Neutrophil to lymphocyte ratio

AGR:

Albumin globulin ratio

SIRS:

Systemic inflammatory response syndrome

UAS:

Ureteral access sheath

OR:

Odds ratio

CI:

Confidence interval

ROC:

Receiver operating characteristic

LPS:

Lipopolysaccharide

LTA:

Lipoteichoic acid

UTI:

Urinary tract infection

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Funding

Funding was provided by the National Natural Science Foundation of China (81770705 to Chen Hequn) and Hunan Natural Science Foundation (no. 2017JJ3482 to Xiaoqiong Zhang).

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Authors and Affiliations

  1. Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China

    Minghui Liu, Zewu Zhu, Yu Cui, Huimin Zeng, Yongchao Li, Fang Huang, Zhongxiao Cui, Feng Zeng, Zhiyong Chen, Yang Li, Jinbo Chen & Hequn Chen

  2. Transplantation Center, Xiangya Hospital, Central South University, Changsha, 410008, China

    Xiaoqiong Zhang

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  1. Minghui Liu
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  2. Zewu Zhu
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Contributions

ML: project development, data analysis and manuscript writing. JC, ZZ, YC: data collection and analysis. HZ, YL, FH and ZC: data collection. FZ, ZC and YL: manuscript editing. CH and XZ: project development, manuscript editing.

Corresponding authors

Correspondence to Xiaoqiong Zhang, Jinbo Chen or Hequn Chen.

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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.

Consent to participate

For this retrospective study, formal consent was not required.

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Written informed consent for publication was obtained from all participants.

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The original online version of this article was revised: The term “thrombus rate” in the last line of Fig.2 was incorrect. Now, it has been corrected to "Urosepsis rate".

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Liu, M., Zhu, Z., Cui, Y. et al. The value of procalcitonin for predicting urosepsis after mini-percutaneous nephrolithotomy or flexible ureteroscopy based on different organisms. World J Urol 40, 529–535 (2022). https://doi.org/10.1007/s00345-021-03845-9

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