The combination of preoperative/2 hours postoperative blood WBC count ratio and qSOFA to predict the urosepsis after flexible ureteroscopic lithotripsy
10.3760/cma.j.cn112330-20200202-00052
- VernacularTitle:术前/术后2 h血白细胞比联合qSOFA对输尿管软镜术后尿脓毒血症的预测价值
- Author:
Yi SHAO
1
;
Jun LU
;
Junhua ZHENG
Author Information
1. 上海交通大学附属第一人民医院泌尿外科 200080
- From:
Chinese Journal of Urology
2020;41(4):282-286
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To discover the efficacy of the combination of preoperative/2 hours postoperative blood WBC count ratio and qSOFA to predict the urosepsis after flexible ureteroscopic lithotripsy.Methods:Retrospectively analyze the patients’ information from September 2015 to July 2018. In total, 2 364 patients who underwent the flexible ureteroscopic lithotripsy procedure were enrolled in the study. Patients gender (male: 1463, female: 751), age (54.9±14.0)years, BMI (23.9±2.8)kg/m 2, stone size(10.8±6.2)mm, side (left: 1 305, right: 1 018, both sides: 41), preoperative body temperature(36.8±0.4)℃, blood glucose level(5.7±1.5)mmol/L, WBC(7.4±4.6)×10 9/L, neutrophil percentage 0.62±0.11, C reactive protein(20.1±59.3)mg/L, procalcitonin(1.6±11.8)μg/L, interleukin-6(11.3±32.9)pg/ml. Results:The operative time was (39.3±23.0) min. The 2 hours postoperative WBC count was (6.7±2.9) ×10 9/L, neutrophil percentage was 0.70±0.12. qSOFA was positive for 69 cases and negative for 2 295 cases. 15 (0.6%) patients developed urosepsis. qSOFA positive patients were 15 in urosepsis group and 54 in normal group. The preoperative/2 hours postoperative blood WBC count ratio was 2.5±1.6 for urosepsis group and 0.7±0.2 for normal group. Univariate analysis showed that female patients(χ 2=16.20, P<0.001), large size of stones( t=2.14, P=0.050), high preoperative blood WBC( t=2.51, P=0.025), neutrophil percentage( t=2.90, P=0.012), C reactive protein( t=2.58, P=0.028), procalcitonin( t=16.09, P<0.001)and interleukin-6( t=7.88, P=0.032), positive preoperative mid-stream sample of urine culture(χ 2=21.10, P<0.001), preoperative/2 hours postoperative blood WBC count ratio >1( t=4.51, P=0.001)and qSOFA positive(χ 2=502.10, P<0.001) were recognized as statistically significant. Patients whose qSOFA was positive as well as preoperative/2 hours postoperative blood WBC count ratio >1 were diagnosed high-risk urosepsis patients. The efficacy of the combining of qSOFA and preoperative/2 hours postoperative blood WBC ratio >1 were higher than using separately. When using qSOFA alone, the area under the receiver operating characteristic curve was 0.98 but the positive prediction value was 21.7%. When using preoperative/2 hours postoperative blood WBC ratio alone, AUROC was 0.98, specificity was 60.0% and positive prediction value is 38.5%. Both indicate that the false positive rates were high. And for combining model, the area under the receiver operating characteristic curve was 1.00, specificity was 98.3% and the positive prediction value was 93.8%. It had a much higher efficacy which was a 2-hour-quick, sufficient and reliable indicator for diagnosing urosepsis. Conclusions:The combination of qSOFA positive and preoperative/2 hours postoperative blood WBC count ratio>1 could quickly and accurately predict the urosepsis after flexible ureteroscopic lithotripsy.
