首页|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

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

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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○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。
Risk factors and predictive model of complicating urosepsis after percutaneous nephrolithotripsy
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 efficien-cy 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 post-operative urogenic sepsis.

urinary calculipercutaneous nephrolithotripsyurinary sepsisrisk factorspredictive model

张大伟、蔡高平、谭扬扬、李宇翔、杨成、张斌、杨旭凯

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甘肃省中心医院泌尿外科,兰州 730000

陆军第七十三集团军医院泌尿外科,厦门福建 361003

甘肃中医药大学第一临床医学院,兰州 730051

空军军医大学研究生院,西安 710032

联勤保障部队第九四○医院泌尿外科,兰州 730050

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尿路结石 经皮肾镜碎石术 尿脓毒血症 危险因素 预测模型

甘肃省自然科学基金项目甘肃省兰州市科技基金项目

21JR11RA0082021-RC-106

2024

重庆医学
重庆市卫生信息中心,重庆市医学会

重庆医学

CSTPCD
影响因子:1.797
ISSN:1671-8348
年,卷(期):2024.53(2)
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