IPS评分联合ALB、PLT、Lac对肾结石患者术后并发尿源性脓毒血症的预测价值

Predictive value of IPS score combined with ALB,PLT,Lac for postoperative urinary sepsis in patients with renal stones

目的探讨感染可能性评分(IPS)联合白蛋白(ALB)、血小板计数(PLT)、乳酸(Lac)对肾结石患者经皮肾镜取石术后并发尿源性脓毒血症的预测价值。方法选取2019年1月至2021年2月在宝鸡市中心医院收治的行经皮肾镜取石术治疗的212例肾结石患者作为研究对象,根据患者术后是否并发尿源性脓毒血症将其分为并发组(24例)和未并发组(188例),对比两组术前、术后IPS评分和ALB、PLT、Lac水平,并采用logistic回归分析法分析肾结石患者经皮肾镜取术后并发尿源性脓毒血症的影响因素,并绘制受试者工作特征(ROC)曲线分析IPS评分联合ALB、PLT、Lac水平对肾结石术后并发尿源性脓毒血症的预测价值。结果并发组的术前尿培养阳性占比、术后IPS评分及Lac水平均高于未并发组,而术后ALB水平及PLT则均低于未并发组(均P<0.05)。经logistic回归分析显示,术前尿培养阳性以及术后IPS评分和Lac水平升高、ALB和PLT水平下降,均是肾结石术后并发尿源性脓毒血症的危险因素(均P<0.05);ROC曲线分析结果显示,术后IPS评分联合ALB、PLT、Lac水平预测肾结石术后并发尿源性脓毒血症的灵敏度、曲线下面积(AUC)均高于单独预测(均P<0.05)。结论术前尿培养阳性以及术后IPS评分和Lac水平升高、ALB和PLT水平下降均是肾结石患者经皮肾镜碎石术后并发尿源性脓毒血症的危险因素。术后IPS评分、ALB、PLT、Lac水平对肾结石术后并发尿源性脓毒血症具有一定的预测价值,但四者联合预测的价值更高。

Objective To explore the predictive value of infection possibility score(IPS)combined with albumin(ALB),platelet count(PLT)and lactic acid(Lac)levels for urogenic sepsis after percutaneous nephrolithotomy lithotripsy in patients with renal calculi.Methods From January 2019 to February 2021,212 patients with renal calculi treated by percutaneous nephrolithotomy lithotripsy in Baoji Central Hospital were selected as the research object.According to whether the patients were complicated with urogenic sepsis after operation,they were divided into concurrent group(24 cases)and non concurrent group(188 cases).The IPS scores and the levels of ALB,PLT and Lac preoperative and postoperative were compared between the two groups.Logistic regression analysis were used to analyze the influencing factors of urinary sepsis after percutaneous nephrolithotomy lithotripsy in patients with renal calculi,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of IPS score combined with the levels of ALB,PLT and Lac for urinary sepsis after renal calculi operation.Results The proportion of preoperative positive urine culture,postoperative IPS score and Lac level in the concurrent group were higher than those in the non-concurrent group,while the postoperative ALB level and PLT were lower than those in the non-concurrent group(all P<0.05).Logistic regression analysis showed that preoperative urine culture positive,and postoperative IPS score and Lac level inceeased,ALB and PLT levels decreased were all risk factors of urinary sepsis after kidney stone surgery(all P<0.05).ROC results showed that the sensitivity and area under the curve(AUC)of postoperative IPS score combined with ALB,PLT and Lac in predicting postoperative urogenic sepsis of renal calculi were higher than those predicted alone(all P<0.05),and there was no significant difference between specificity and prediction alone(P>0.05).Conclusions Positive preoperative urine culture,postoperative IPS score and Lac level increased,ALB and PLT levels decreased are all risk factors for urinary sepsis after percutaneous nephrolithotomy lithotripsy in patients with renal calculi.The postoperative IPS score,ALB,PLT and Lac levels have a certain predictive value for urinary sepsis after renal calculi surgery,but the combined predictive value of the four is higher.