Establishment of early warning scoring system for systemic inflammatory response syndrome after upper ureteral calculi lithotripsy
Objective To investigate the influencing factors of systemic inflammatory response syndrome(SIRS)in patients with ureteral calculi after upper ureteral calculi lithotripsy,and to estab-lish an early warning scoring system.Methods From January 2020 to October 2022,clinical data of 292 patients with upper ureteral calculi who underwent upper ureteral calculi lithotripsy in our hospital were analyzed retrospectively.The study objects were divided into training set(219 cases)and test set(73 cases)at a ratio of 3∶1 by random number table.The patients in the training set were divided in-to non SIRS group(185 cases)and SIRS group(34 cases)according to whether SIRS occurred after surgery.The differences in clinical data between the two groups were compared,The influencing factors of SIRS were discussed through multifactor logistic regression model,and a personalized early warning scoring system was constructed accordingly.Results In the training set,34 patients(15.53％)de-veloped SIRS after surgery.In the SIRS group,the stone load was higher,the proportion of patients with stone surgery history,diabetes,multiple stones,positive urine bacterial culture before surgery was higher,the degree of hydronephrosis was more serious,the preoperative urine white blood cell count,blood PCT,C-reactive protein 24 hours after operation and bacterial endotoxin 24 hours after operation levels were higher,and the operation time was longer(all P＜0.05).The results of multivariate logis-tic regression analysis showed that the degree of hydronephrosis,preoperative urine white blood cell count,stone load,operation time,positive urine bacterial culture before operation,blood PCT and bacterial endotoxin 24 hours after operation were all independent risk factors for SIRS(all P＜0.05).The constructed early warning scoring system scored 0-11 points,and there was no significant differ-ence in Hosmer-Lemeshow goodness of fit between the training set and the test(P＞0.05).The area under the receiver operating characteristic(ROC)curve(AUC)of the training set was 0.758(95％CI:0.721-0.795),and the AUC of the test set was 0.776(95％CI:0.749-0.803).When the predicted score was 6,the Yoden index was the largest(0.607).Conclusions The degree of hydro-nephrosis,preoperative urine white blood cell count,stone load,operation time,preoperative positive urine bacterial culture,blood PCT and bacterial endotoxin 24 hours after operation are all independent risk factors for SIRS in patients.The early warning scoring system constructed has high accuracy and differentiation,which can be used as a reference tool for risk assessment of SIRS in such patients.
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