临床外科杂志 ›› 2023, Vol. 31 ›› Issue (5): 470-474.doi: 10.3969/j.issn.1005-6483.2023.05.018

• 论著 • 上一篇    下一篇

全身免疫炎症指数预测上尿路结石术后尿脓毒血症发生的列线图模型

  

  1. 200434  同济大学附属上海市第四人民医院泌尿外科
  • 收稿日期:2022-06-06 修回日期:2022-06-26 出版日期:2023-05-20 发布日期:2023-05-20
  • 通讯作者: 李杜渐,Email:djl00777@163.com

A nomogram model of systemic immune inflammation index for predicting the occurrence of urosepsis after upper urinary calculi surgery

  1. Department of Urology,Shanghai Fourth People’s Hospital affiliated to Tongji University,Shanghai 200434,China
  • Received:2022-06-06 Revised:2022-06-26 Online:2023-05-20 Published:2023-05-20

摘要: 目的 探讨术前全身免疫炎症指数(systemic immune-inflammation,SII)与输尿管软镜碎石术后尿脓毒血症发生的相关性的预测价值,并建立术前列线图预测模型。方法 回顾性分析2020年8月~2021年10月我院接受输尿管软镜碎石术治疗的329例病人的临床资料。依据术后是否发生尿脓毒血症,分为脓毒血症组及非脓毒血症组。采用单因素及多因素Logistic回归分析各指标与尿脓毒血症的相关性。根据受试者工作特征(receiver operating characteristic,ROC)曲线确定相关临床指标的临界值,并计算曲线下面积(the area under curve ,AUC)评估其诊断效能。最后基于风险模型筛选的独立预测因素,应用R软件建立预测术后尿脓毒血症发生的列线图模型并计算C-index,通过校准曲线评估其准确性。结果 本研究共19例(5.8%)病人术后发生脓毒血症。多因素分析显示,女性(OR=5.407,P=0.014),手术时间(OR=1.029,P=0.039),结石直径(OR=6.311,P=0.041),SII(OR=1.005,P<0.001),快速序贯器官衰竭评分(quick sepsis related organ failure assessment,qSOFA)阳性(OR=2.056,P=0.034)是输尿管软镜碎石术后尿脓毒血症的独立危险因素。年龄、体质指数、高血压、糖尿病、术前血肌酐、术前尿培养与术后尿脓毒血症发生无相关性。ROC曲线分析提示,SII的AUC为0.908,高于其他全身炎症指标。结论 术前SII可以作为输尿管软镜碎石术后尿脓毒血症发生的独立预后因素,作为一种新型的全身炎症指标,其预测价值优于其他传统指标。纳入性别、结石直径、手术时间、SII和qSOFA评分的列线图模型可提高术后尿脓毒血症早期预测的准确性。

关键词: 全身免疫炎症指数, 尿脓毒血症, 输尿管软镜碎石, 列线图

Abstract: Objective To investigate the value of preoperative systemic immune-inflammation index (SII) in predicting postoperative urosepsis after flexible ureteroscopic lithotripsy,and establish a preoperative nomogram prediction model.Methods The clinical data of 329 patients who underwent flexible ureteroscopic lithotripsy in Shanghai Fourth People’s Hospital affiliated to Tongji University from August 2020 to October 2021 were retrospectively analyzed.According to the occurrence of urinary sepsis, the patients were divided into sepsis group and non-sepsis group.The independent risk factors of postoperative urosepsis for upper urinary calculi were evaluated by univariate and multivariate Logistic regression analysis.We drew receiver operating characteristic (ROC) to find the cut-off value of risk factors and calculated the area under curve (AUC) to evaluate its diagnostic power.The R software was used to establish a nomogram model for predicting the occurrence of postoperative urosepsis and calculate the c-index.And its accuracy was evaluated by the calibration curve.

Key words: systemic immune-inflammation, urosepsis, flexible ureteroscopic lithotripsy, nomogram

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