泌尿系结石术后并发全身炎症反应综合征的列线图分析及其应用价值

Analysis and application value of the nomogram for systemic inflammatory response syndromeafter urinary calculi surgery

目的:探讨泌尿系结石术后并发全身炎症反应综合征(SIRS)的影响因素,构建列线图预测模型并分析其预测价值。方法:选取2019年8月至2022年5月本院收治的512例泌尿系结石患者,根据术后是否发生SIRS分为SIRS组(n=75)、无SIRS组(n=437),比较两组临床资料,采用多因素logistic回归模型分析泌尿系结石术后并发SIRS的影响因素,采用R软件绘制预测并发SIRS的列线图模型,采用受试者工作特征(ROC)曲线分析列线图预测模型的预测效能。结果:SIRS组糖尿病、尿白细胞阳性和鹿角结石患者所占比例及术中灌注压高于无SIRS组,手术时间长于无SIRS组(均P<0.05)。多因素logistic回归分析显示,合并糖尿病(OR=8.268,95%CI:1.058~64.613)、尿白细胞阳性(OR=10.631,95%CI:2.641~42.796)、术中灌注压高(OR=8.540,95%CI:1.279~57.025)、有鹿角结石(OR=14.569,95%CI:3.112~68.209)、手术时间长(OR=10.552,95%CI:1.362~81.748)均为SIRS的危险因素(均P<0.05)。预测泌尿结石术后并发SIRS的列线图模型显示C指数为0.951。泌尿系结石术后并发SIRS的列线图模型的ROC曲线下面积(AUC)为0.951(95%CI:0.226~0.984),灵敏度为82.67%,特异度为85.81%。结论:尿白细胞阳性、鹿角结石、术中灌注压等为泌尿系结石术后并发SIRS的影响因素,该列线图预测模型对术后并发SIRS有一定的预测价值。

Objective:To investigate the influencing factors of systemic inflammatory response syndrome(SIRS)after urinary calculi surgery,and to construct a nomogram prediction model and analyze its predictive value.Methods:A total of 512 patients with urinary calculi admitted to our hospital from August 2019 to May 2022 were selected.According to whether SIRS occurred after surgery,they were divided into SIRS group(n=75)and non-SIRS group(n=437).The clinical data of the two groups were compared and a multivariate logistic regression model was used to analyze the influencing factors of SIRS after urinary calculi surgery.The R language was used to draw a nomogram model for predicting concurrent SIRS,and the receiver operating characteristic(ROC)curve was used to analyze the predictive performance of the nomogram prediction model.Results:The proportion of patients with diabetes mellitus,positive urinary leukocytes and staghorn calculi and the intraoperative per-fusion pressure were higher in the SIRS group than in the non-SIRS group,and the operation time was longer in the SIRS group than in the non-SIRS group(all P<0.05).Multivariate logistic regression analysis showed that co-existing diabetes mellitus(OR=8.268,95%CI:1.058-64.613),positive urinary leukocytes(OR=10.631,95%CI:2.641-42.796),high intraoperative perfusion pressure(OR=8.540,95%CI:1.279-57.025),staghorn calculi(OR=14.569,95%CI:3.112-68.209),and long operation time(OR=10.552,95%CI:1.362-81.748)were risk factors for SIRS(all P<0.05).The nomogram model for predicting SIRS after urinary calculi surgery showed that the C-index was 0.951.The area under the ROC curve(AUC)of the nomogram model for predicting SIRS after urinary calculi surgery was 0.951(95%CI:0.226-0.984),the sensitivity was 82.67%and the specificity was 85.81%.Conclusion:Positive urinary leuko-cytes,staghorn calculi and intraoperative perfusion pressure are the influencing factors of SIRS after urinary calculi surgery and the nomogram prediction model has a certain predictive value for SIRS after urinary calculi surgery.