输尿管软镜碎石术后寒战进展至发热危险因素评估及列线图预测模型构建

Evaluation of the risk factors of progress from post-RIRS shivering to fever and establishment of nomogram prediction model

目的:评估输尿管软镜碎石术(RIRS)术后寒战进展至发热的危险因素,并构建了列线图预测模型对RIRS术后发热作出早期预判。方法:回顾性分析2018年1月—2021年12月广州医科大学附属第一医院273例RIRS术后寒战患者资料,比较发热组和非发热组的临床资料,采用多因素logistic回归分析确定发热的危险因素,并构建列线图预测RIRS术后寒战到发热的进展。结果:在多因素logistic回归分析中,术前尿沉渣试验阳性(OR=4.99,95%CI:1.77~14.79,P<0.01)、术后血白细胞计数异常(OR=2.51,95%CI:1.15~5.57,P=0.02)和术后中性粒细胞比率>80%(OR=2.59,95%CI:1.15~6.18,P=0.03)被确定为RIRS术后寒战进展至发热的独立危险因素。结论:对于RIRS术后寒战患者,术前尿沉渣试验阳性和术后血常规检查阳性(白细胞计数>12 000个/mm3或<4000个/mm3,或中性粒细胞比例>80%)即可对术后感染做出鉴别诊断。

Objective: To explore the independent risk factors of progress from post-RIRS shivering to fever and construct a nomogram to early predict the fever episodes. Methods: Two hundred and seventy-three cases with post-RIRS shivering in First Affiliated Hospital of Guangzhou Medical University from January 2018 to December 2021 were reviewed, and clinical data were compared between fever group and non-fever group. Risk factors were identified by multivariate logistic regression analysis, and a nomogram was constructed to early predict the progress from post-RIRS shivering to fever. Results: In multivariate logistic analysis, preoperative positive urine sediment test(OR=4.99, 95%CI: 1.77-14.79, P<0.01), postoperative abnormal WBC count(OR=2.51, 95%CI: 1.15-5.57, P=0.02) and postoperative neutrophil ratio>80%(OR=2.59, 95%CI: 1.15-6.18, P=0.03) were identified as independent risk factors of the progress from post-RIRS shivering to fever. Conclusion: For patients with post-RIRS shivering, preoperative positive urine sediment test and postoperative blood routine test(WBC count>12 000 cells/mm~3 or<4000 cells/mm~3, or neutrophil ratio>80%) were able to make a quick differential diagnosis of post-RIRS infection.