If the patients had preoperative infection, the infectious index (fever, UC, urine test, and urine WBC) in the infectious episode were recorded. All the factors closed to surgery were obtained. Potential predictors were collected from our hospital’s database, and they included the following: patient age and sex, body mass index (BMI), presence of comorbidities (hypertension, coronary heart disease, and diabetes mellitus), stone height, prior indwelling stent, hydronephrosis, cholesterol and creatinine concentrations, serum albumin and globulin concentrations, pre-operative fever (defined as body temperature >38 ☌), white blood cell (WBC) count, pre-operative UC, urine nitrite concentration, and urine WBC count (positive result refers to urine WBC ≥50/µL in urine sediment analysis). The primary outcome was post-operative sepsis within 48 hours of surgery. After lithotripsy, 6-Fr double-J stent was routinely inserted in all cases for 2 weeks. Holmium: yttrium-aluminum-garnet laser was used to fragment the stones. Intrarenal pressure was stabilized by a pressure-sensitive pump (Shenda Medical, China). A 14-Fr ureteral access sheath (Cook Medical, Bloomington, IN) was then passed over the wire to the ureteropelvic junction, and 7.5-Fr fURS (Flex-X2, Karl Storz, Germany) was performed through the sheath. A 0.035 mm guidewire was advanced through the urethral and ureteral meatuses to the renal pelvis under direct rigid ureteroscope vision. Rigid ureteroscopy was routinely used for ureteral dilatation before fURS. If a double-J stent was inserted pre-operatively, it was removed at the beginning of surgery. All the surgeries were performed by experienced urologists. Patients with no indicators of infection were administered a dose of prophylactic antibiotics. Patients with indicators of infection, such as positive UC, fever, and leukocytosis, received at least a full antibiotic regimen (second-generation cephalosporins or levofloxacin) for 7 days until these infection indicators turned negative. Blood sample for liver function (including albumin and globulin) was routinely collected and analyzed after an overnight fast before surgery. Proximal ureteral stones were confirmed by abdominal computed tomography, which was located above the fourth lumbar spine or in the ureteropelvic junction. The initial cutoff value of AGR was set at 1.2 based on the Youden index of the receiver operating characteristic (ROC) curves, which showed the highest sensitivity and specificity. Septic shock was defined as sepsis with persistent systolic arterial pressure 40 mmHg from baseline ( 14). Accepted for publication Aug 28, 2020.įlexible ureteroscopy (fURS) is recommended as first-line treatment for proximal ureteral stones 38 ☌ (II) heart rate >90/minute (III) respiratory rate >20/minute and (IV) leukocyte count 12,000 cells/µL ( 14). Keywords: Sepsis flexible ureteroscopy (fURS) albumin globulin ratio (AGR) ureteral stone positive urine culture (positive UC) Cautious pre-operative evaluation and optimized treatment strategy should be considered to minimize infectious complications. Then patients were categorized by different AGR level (“≥1.4”, “1.2–1.4”, “1.0–1.2”, “<1.0”), and corresponding sepsis rates were 27.7%, 9.8%, 4.5% and 2.5%.Ĭonclusions: Positive UC and low AGR were independent predictors of post-fURS sepsis. When AGR <1.2 and positive UC were combined, area under the receiver operator characteristic curve was 0.825. Multivariate analysis identified AGR <1.2 and positive UC (OR =10.520, 95% CI: 4.489–24.653, P<0.001) as independent predictors. Univariate analysis showed that age, female sex, albumin concentration, globulin concentration, AGR, pre-operative fever, white blood cell (WBC) count, urine culture (UC) result, urine WBC count, and urine nitrite result were predictors of sepsis. Results: Sepsis occurred in 43 patients (5.7%), and 6 (0.8%) of them developed septic shock. Then A nomogram was generated using the predictors. Univariate and multivariate logistic regression analyses were performed to identify predictors of sepsis after fURS in patients with solitary proximal ureteral stones. Methods: Overall, 759 patients who underwent fURS were retrospectively enrolled. Policy of Dealing with Allegations of Research Misconductīackground: To identify predictors of sepsis after flexible ureteroscopy (fURS) in patients with unilateral, solitary, proximal ureteral stones and evaluate the association between albumin-globulin ratio (AGR) and sepsis.Policy of Screening for Plagiarism Process.
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