经皮肾镜碎石术后并发尿源性脓毒血症的危险因素及预测模型研究

Risk factors and predictive model of complicating urosepsis after percutaneous nephrolithotripsy

目的探讨经皮肾镜碎石术(PCNL)后并发尿源性脓毒血症的危险因素,并构建列线图预测模型。方法回顾性分析2016年10月至2021年10月就诊于联勤保障部队第九四〇医院行一期PCNL的291例患者资料,根据术后是否并发尿源性脓毒血症分为脓毒血症组和非脓毒血症组。纳入一般资料、结石相关资料、手术相关资料及实验室检查的相关数据,通过单因素及多因素logistic回归分析方法,筛选独立危险因素,并构建列线图预测模型。结果单因素及多因素回归分析结果示:年龄≥60岁(OR=6.438,95%CI:1.548~26.769)、尿白细胞3+(OR=5.651,95%CI:1.614~31.766)、尿亚硝酸盐阳性(OR=7.117,95%CI:1.190~42.561)、手术时间≥90 min(OR=4.626,95%CI:1.137~18.817)、灌注量≥30 L(OR=3.312,95%CI:1.090~10.061)为PCNL后并发尿源性脓毒血症的独立危险因素(P<0.05)。所构建的列线图预测模型在建模样本中C-index为0.937,校准C-index为0.914,模型预测效能较好。结论年龄≥60岁、尿白细胞3+、尿亚硝酸盐阳性、手术时间≥90 min、灌注量≥30 L为PCNL后并发尿源性脓毒血症的独立危险因素;构建的列线图预测模型对术后尿源性脓毒血症的发生有较好的预测效能。

Objective To explore the risk factors of complicating urogenic sepsis after percutaneous nephrolithotripsy(PCNL)and construct a nomogram prediction model.Methods The data of 291 patients with stage 1 PCNL in 940 Hospital of Joint Logistics Support Force from October 2016 to October 2021 were retrospectively analyzed.The patients were divided into the sepsis group and non-sepsis group according to whether complicating urogenic sepsis after operation.The general data,stone-related data,operation-related data and laboratory detection related data were included.The independent risk factors were screened by the univariate and multivariate logistic regression analysis,and the nomogram prediction model was constructed.Results The results of univariate and multivariate logistic regression analysis showed that age≥60 years old(OR=6.438,95%CI:1.548-26.769),urinary leukocyte 3+(OR=5.651,95%CI:1.614-31.766),urinary nitrite positive(OR=7.117,95%CI:1.190-42.561),operation time≥90 min(OR=4.626,95%CI:1.137-18.817)and perfusion volume≥30 L(OR=3.312,95%CI:1.090-10.061)were the independent risk factors of postoperative complicating urogenic sepsis.C-index of the constructed nomogram prediction model in the modeling samples was 0.937,the calibrated C-index was 0.914,and the model predictive efficiency was good.Conclusion Age≥60 years old,urinary leukocyte 3+,urinary nitrite positive,operation time≥90 min and perfusion volume≥30 L are the independent risk factors for complicating urogenic sepsis after PCNL;the constructed nomogram prediction model has a good predictive efficiency for the occurrence of postoperative urogenic sepsis.