经皮肾镜碎石术后尿源性脓毒血症的临床预测模型  

Clinical prediction model of urogenic sepsis after percutaneous nephrolithotomy

作　　者：袁龙平 陈令秋[1] 王鹏 乙从亮[1] Yuan Longping;Chen Lingqiu;Wang Peng;Yi Congliang(Department of Urology,the People′s Hospital of Huaibei City,Huaibei 235000,China)

机构地区：[1]淮北市人民医院泌尿外科,淮北235000

出　　处：《国际泌尿系统杂志》2024年第5期785-789,共5页International Journal of Urology and Nephrology

摘　　要：目的建立经皮肾镜碎石术(PCNL)后引起尿源性脓毒血症的危险因素的预测模型。方法回顾性分析2018年8月至2022年8月本院行PCNL治疗的220例肾结石、输尿管上段结石患者的临床资料,依据术后是否进展为脓毒血症将患者分成尿源性脓毒血症组(21例)及非尿源性脓毒血症组(199例),并分别对两组患者的年龄、性别、体质量指数(BMI)、糖尿病史、尿常规、尿培养等影响因素进行单因素和多因素分析,建立相对应的列线图预测模型。结果多因素logistic回归分析结果显示,糖尿病史(OR=7.64,P=0.002)、尿培养(OR=2.97,P=0.021)、肾积水CT值(OR=4.52,P=0.013)、结石数量(OR=4.25,P=0.032)、鹿角形结石(OR=3.70,P=0.036)均是PCNL术后发生脓毒血症的独立危险因素。预测模型的曲线下面积为0.919,Hosmer-Lemeshow检验提示预测模型具有良好的区分度和校准度(χ^(2)=4.069,P=0.851)。结论糖尿病史、中段尿培养、肾积水CT值、结石数量、鹿角形结石是PCNL术后发生尿源性脓毒血症的独立危险因素。ObjectiveTo establish a predictive model for risk factors causing urogenital sepsis after percutaneous nephrolithotomy(PCNL).MethodsThe clinical data of 220 patients with kidney stones,upper ureteral stones who underwent PCNL in our department from August 2018 to August 2022 were retrospectively analyzed and divided into urogenic sepsis group(21 cases)and non-urogenic sepsis group(199 cases)based on whether they progressed to sepsis after surgery,and their influencing factors such as age,gender,body mass index(BMI),history of diabetes,urinary routine and urine culture were analyzed univariately and multifactorially,respectively.Corresponding line graph prediction models were established.ResultsThe results of multivariate logistic regression analysis showed that the independent risk factors for postoperative progression to sepsis were history of diabetes mellitus(OR=7.64,P=0.002),urine culture(OR=2.97,P=0.021),CT value of hydronephrosis(OR=4.52,P=0.013),number of stones(OR=4.25,P=0.032),and deerstalker-shaped stones(OR=3.70,P=0.036).The AUC of the prediction model was 0.919,as suggested by the Hosmer-Lemeshow test,revealing a prediction model with good discrimination and calibration(χ^(2)=4.069,P=0.851).ConclusionsHistory of diabetes mellitus,midstream urine culture,CT value of hydronephrosis,number of stones,and antler-shaped stones are independent risk factors for urogenital sepsis after PCNL.

关 键 词：脓毒症 肾造口术 经皮 碎石术 

分 类 号：R459.7[医药卫生—急诊医学] R699[医药卫生—治疗学]