The predictive value of the quick sequential organ failure assessment score in septic shock after percutaneous nephrolithotomy / 中华泌尿外科杂志

ABSTRACT

Objective:To evaluate the predictive value of the quick sequential organ failure assessment(qSOFA) score in septic shock after percutaneous nephrolithotomy(PCNL).Methods:309 patients who underwent PCNL at the First Affiliated Hospital of Soochow University between May 2018 and October 2019 were retrospectively reviewed. Among them, there were 192 men and 117 women, whose mean age was (51.4±12.8)years (range from 20 to 79 years). There were 82 cases(26.5%) of hypertension and 23 cases(7.4%) of diabetes. There were 88 patients(28.5%) with positive preoperative urine culture.102 patients(33.0%) were diagnosed with staghorn calculi by abdominal CT and urinary tract abdominal plain film(KUB).78 patients(25.2%) had a history of urinary surgery. The qSOFA and SIRS were evaluated to all patients within 24 h after PCNL and the best diagnostic criteria was considered as qSOFA≥2 and SIRS≥2. Receiver operating characteristic(ROC) curves were constructed and the areas under the curve(AUC) were calculated to compare the discriminatory ability of qSOFA and SIRS with the post-PCNL septic shock. A univariate logistic regression analysis was used to identify the covariates associated with post-PCNL sepsis. Then adjusted multivariate analysis was used to identify the predictive value of positive qSOFA and SIRS for the postoperative clinical outcomes including postoperative hospitalization days, postoperative blood transfusion, postoperative re-intervention, residual stone, planned readmission within 30 days and unplanned readmission within 30 days.Results:Among the 309 patients who underwent PCNL, 23 patients(7.4%) met the positive qSOFA criterion while 84 patients(27.2%) developed to SIRS. 7 patients(2.3%) were admitted to ICU after operation and were eventually diagnosed as septic shock, among which 6 patients met the criteria of qSOFA and SIRS. 8 patients(2.6%) underwent multi-channel operation. The median operative time of 309 patients was 85(56, 115) min. Postoperative calculus composition analysis showed that 64 patients(20.7%) were infectious calculi. Postoperative KUB showed residual calculi in 179 patients (57.9%). The median postoperative hospital stay was 7(6, 9) days. 10 patients(3.2%) received blood transfusion. 9 patients(2.9%) received re-intervention after surgery. There were 41 patients (13.3%) of planned readmissions and 16 cases (5.2%) of unplanned readmissions within 30 days. The AUC of qSOFA and SIRS was 0.900 and 0.799 respectively. The qSOFA had a higher specificity, positive likelihood ratio and positive predictive value(94.4%, 15.23, 26.1%)than that of SIRS(74.2%, 3.32, 7.1%)for septic shock. In univariate logistic regression analysis significant associations were observed between positive urine culture, stone size, staghorn stones, struvite stones, surgery history, operation time and sepsis after PCNL. Multivariate logistic regression analysis revealed that postoperative length of stay( OR=1.237, 95% CI 1.048-1.459, P=0.012) and postoperative transfusion( OR=8.265, 95% CI 1.409-48.481, P=0.019) were closely associated with qSOFA after adjusting for covariates shown to be related to post-PCNL sepsis mentioned above. Conclusions:The qSOFA could be superior to SIRS in predicting septic shock after PCNL.