Preliminary establishment of a risk scoring system for postoperative urosepsis after retrograde intrarenal surgery
10.3760/cma.j.cn431274-20240925-01472
- VernacularTitle:输尿管软镜碎石取石术后尿脓毒血症风险评分系统的构建
- Author:
Wenya AN
1
;
Yaming LAI
1
;
Xianzhong WANG
1
;
Zugang SUN
1
;
Dapeng HE
1
;
Zhong WANG
1
Author Information
1. 广元市中心医院泌尿外科，广元 628000
- Publication Type:Journal Article
- Keywords:
Kidney calculi;
Flexible ureteroscope;
Urosepsis;
Risk rating
- From:
Journal of Chinese Physician
2025;27(10):1521-1526
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To construct a risk scoring system for predicting the risk of postoperative urosepsis by analyzing the perioperative risk factors of retrograde intrarenal surgery (RIRS).Methods:A retrospective study was conducted on 180 patients with renal calculi admitted to the Guangyuan Central Hospital from January 2019 to December 2020. Among them, 30 patients who developed urosepsis after RIRS were included in the observation group. Using a nested case-control study design, 150 patients without urosepsis during the same period were selected as the control group at a 1∶5 matching ratio. Logistic regression analysis was used to screen the independent risk factors for postoperative urosepsis after RIRS, and a risk scoring system for postoperative urosepsis after RIRS was established based on the logical scoring method. Fifty percent of the cases (90 cases in total) from the above model were selected as validation samples. The model performance was evaluated using discrimination and calibration indicators. The receiver operating characteristic (ROC) curve was used to assess the discriminative ability of the scoring system, and the goodness-of-fit test was used to measure its calibration ability. High-risk patients were identified according to the optimal cut-off value of the ROC curve.Results:Multivariate logistic regression analysis showed that female gender ( β=1.575, P=0.003), positive urine nitrite (NIT) ( β=2.019, P<0.001), peripheral blood neutrophil-to-lymphocyte ratio (NLR)≥2.5 ( β=1.491, P=0.005), operation time>90 minutes ( β=1.716, P=0.005), and procalcitonin (PCT)>0.5 ng/ml ( β=1.347, P=0.011) were independent risk factors for postoperative urosepsis after RIRS. Using the above 5 factors, a risk scoring system for postoperative urosepsis after RIRS (referred to as the " WNNOP Scoring System" ) was constructed based on the logical scoring method: 1 point for female gender, 1 point for positive urine NIT, 1 point for peripheral blood NLR≥2.5, 1 point for operation time>90 minutes, and 1 point for PCT>0.5 ng/ml, with a total score of 5 points; a score≥3 points indicated a high-risk population. The area under the ROC curve (AUC) of the WNNOP Scoring System for predicting postoperative urosepsis after RIRS was 0.893(95% CI: 0.835-0.952, P<0.001). The goodness-of-fit test showed no statistically significant difference between the predicted and actual values of the model (χ 2=2.229, P=0.898). Fifty percent of the cases (90 cases in total) were randomly selected from the model samples for internal validation. The results showed that the AUC of the ROC curve of the scoring system was 0.877(95% CI: 0.786-0.968, P<0.001), and the goodness-of-fit test showed no statistically significant difference between the predicted and actual values of the model (χ 2=10.040, P=0.186), indicating that the risk scoring system had good performance in terms of discrimination and calibration. Conclusions:The WNNOP Scoring System developed in this study can initially assess the risk of postoperative urosepsis in patients undergoing RIRS. If the score is ≥3 points, close attention should be paid during the perioperative period and relevant preventive measures should be taken.
