输尿管镜碎石围手术期预测脓毒症的风险因子构建与验证

Construction and Verification of Sepsis Risk Factors after Ureteroscopic Lithotripsy

目的:分析输尿管镜碎石围手术期发生脓毒症的危险因素,构建联合预测模型,并验证其预测效能。方法:选取2016年1月—2021年6月我院泌尿外科收治的输尿管结石患者250例,发生脓毒血症为观察组(n=50),未发生脓毒血症为对照组(n=200)。对两组患者的一般资料进行单因素和多因素Logistic回归分析。并通过独立危险因素的回归系数构建联合预测模型,计算截断点。绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)验证预测模型的准确性,并用另一组30例输尿管镜碎石患者作为验证组,验证该模型的预测效能。结果:两组糖尿病、尿白细胞、血中性粒细胞百分比、输尿管结石位置及结石长度差异有统计学意义(P<0.05)。多因素Logistic分析显示,糖尿病、尿白细胞、血中性粒细胞百分比、输尿管结石位置是输尿管镜碎石围手术期发生脓毒血症的联合危险因素(P<0.05)。联合预测因子=0.741×糖尿病+0.651×尿白细胞+0.405×血中性粒细胞百分比+0.328×输尿管结石位置,通过计算得出联合预测因子的截断点为1.758。对联合预测因子行Hosmer-lemeshow拟合优度检验(χ^(2)=1.975,P=0.547)。将联合预测模型及其截断点应用于30例输尿管碎石围手术期患者,经联合预测模型预测正确率为70.0%,敏感度66.7%,特异度83.3%,AUC为0.819。结论:联合预测模型对输尿管镜碎石围手术期发生脓毒血症的评估效能较好,为输尿管镜碎石围手术期发生脓毒症提供早期防治策略。

Objective To construct a combine predictor and verify its predictive efficacy by analyzing the risk factors of sepsis associated with ureteroscopic lithotripsy(URL).Methods 250 patients with ureteral calculi who underwent ureteroscopic lithotripsy admitted to the department of urology in our hospital from January 2016 to June 2021 were analyzed retrospectively.The observation group with sepsis(n=50)and the control group without sepsis(n=200)were divided.The general data of the two groups were analyzed by univariate and Logistic multivariate analysis,the receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated,the joint predictor was constructed through the regression coefficient of independent risk factors and the cut-off point was calculated.It was applied to another group of 30 patients with ureteral calculi for ureteroscopic lithotripsy to verify its prediction efficiency.Results Single factor analysis showed that diabetes,urine leukocyte(UWB),percentage of blood neutrophils(N%),ureteral calculi location and length of stones were correlated with sepsis(P<0.05).Multivariate analysis of diabetes,urine leukocytes,blood neutrophil percentage(N%)and ureteral stone location were independent risk factors for ureteral lithotripsy with sepsis(P<0.05).Risk score=0.741×Diabetes+0.651×Urinary leukocyte+0.405×N%+0.328×ureteral stone locatio.The cut-off point of ureteral calculi was 1.758.Hosmer lemeshow goodness of fit test(χ^(2)=1.975,P=0.547).The combined predictors and cutoff points were applied to 30 perioperative patients with ureteral lithotripsy.The prediction accuracy was 70.0%,sensitivity 66.7%,specificity 83.3%and AUC 0.819.Conclusion The combined predictors are effective in evaluating the perioperative sepsis of ureteroscopic lithotripsy,and it could provide early prevention and treatment strategies for the perioperative sepsis of ureteroscopic lithotripsy.