Abstract Purpose: To assess the pre-operative risk factors for post-operative urosepsis following mini-percutaneous nephrolithotomy (mPCNL) in patients with large kidney stones. Methods：Records of 171 patients with large (≥30mm) kidney stones who underwent mPCNL from December 2013 to October 2019 were reviewed. Demographic data of patients, pre-operative urine analysis, urine culture, routine blood tests and abdominal computerized cosmography data were collected and analyzed. A predictive nomogram model was established based on the results of logistic regression. Results: 29 patients (17%) developed post-operative urosepsis in this study. Univariate analysis demonstrated that preoperative urine leukocytes (P <0.001), urine nitrite (P <0.001), stones in adjacent calices on the coronal plane (P <0.001), the maximum cross-sectional area of stones (P <0.001), the diameter of hydronephrosis (P =0.010) and number of stones (P=0.044) were associated with post-operative urosepsis after mPCNL in patients with large kidney stones. And pre-operative urine leukocytes ≥450/ µl (P=0.002) was the only independent risk factor for post-operative urosepsis in multivariate logistic regression analysis. Based on the results of multivariate regression, a nomogram model was established for the prediction of post-operative urosepsis with ideal discrimination (area under receiver operating characteristic curve was 0.867). Conclusion: Patients with certain pre-operative characteristics, including higher urine leukocytes, positive urine nitrite, stones in adjacent calices on the coronal plane, larger maximum cross-sectional area of stones, larger diameter of hydronephrosis and larger number of stones, who received mPCNL may have a higher risk of postoperative urosepsis. A predictive model can help urologists identify patients who may develop post-operative urosepsis with high probability.

中文翻译：

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大肾结石患者微型经皮肾镜取石术后尿脓毒症的术前危险因素分析

摘要 目的：评估大肾结石患者微型经皮肾镜取石术（mPCNL）术后尿脓毒症的术前危险因素。方法：回顾2013年12月至2019年10月接受mPCNL的171例大（≥30mm）肾结石患者的病历。收集和分析患者的人口统计学数据、术前尿液分析、尿液培养、血常规检查和腹部计算机宇宙学数据。基于逻辑回归结果建立预测列线图模型。结果：本研究中有 29 名患者 (17%) 出现了术后尿脓毒症。单因素分析显示，术前尿白细胞（P<0.001）、尿亚硝酸盐（P<0.001）、冠状面相邻杯状结石（P<0.001）、大肾结石患者mPCNL术后最大结石截面积（P<0.001）、肾积水直径（P=0.010）和结石数量（P=0.044）与术后尿脓毒症相关。而术前尿白细胞≥450/μl（P=0.002）是多因素logistic回归分析中术后尿脓毒症的唯一独立危险因素。基于多元回归结果，建立了具有理想判别力（受试者工作特征曲线下面积为0.867）预测术后尿脓毒症的列线图模型。结论：患者具有一定的术前特征，包括尿白细胞较高、尿亚硝酸盐阳性、冠状面相邻肾盏结石、结石最大截面积较大、肾积水直径越大、结石数量越多，接受 mPCNL 的患者术后尿脓毒症的风险可能更高。预测模型可以帮助泌尿科医生识别可能发生术后尿脓毒症的高概率患者。