摘要
目的探讨术前/术后2 h血白细胞比联合快速序贯器官衰竭评分(qSOFA)对输尿管软镜术后发生尿脓毒血症的预测价值。方法回顾性分析2015年9月至2018年7月于上海交通大学附属第一人民医院因上尿路结石行输尿管软镜碎石取石术患者的病例资料。共2364例患者,男1613例,女751例。年龄(54.9±14.0)岁。体质指数(23.9±2.8)kg/m^2。结石最大径(10.9±6.2)mm。结石位于左侧1305例,右侧1018例,双侧41例。术前体温(36.8±0.4)℃。血糖(5.7±1.5)mmol/L。血WBC(7.4±4.6)×10^9/L,中性粒细胞0.62±0.11。C反应蛋白(20.1±59.3)mg/L,降钙素原(1.6±11.8)μg/L,白细胞介素-6(11.3±32.9)pg/ml。术前清洁中段尿细菌培养阳性465例。qSOFA诊断尿脓毒血症的标准为:①呼吸频率≥22次/分;②收缩压≤100 mmHg(1 mmHg=0.133 kPa);③精神状态改变。满足1项记1分,qSOFA≥2分为阳性,诊断为尿脓毒血症。结果本研究2364例的手术时间(39.3±23.0)min。术后2 h血WBC(6.7±2.9)×10^9/L,中性粒细胞0.70±0.12。qSOFA评分阳性69例,阴性2295例。15例术后发生尿脓毒血症,发生率为0.6%。尿脓毒血症组和非尿脓毒血症组qSOFA阳性患者例数分别为15例和54例,术前/术后2 h血WBC比分别为2.5±1.6和0.7±0.2。单因素分析结果显示:女性(χ^2=16.20,P<0.001)、结石体积大(t=2.14,P=0.050)、术前血WBC(t=2.51,P=0.025)、中性粒细胞(t=2.90,P=0.012)、C反应蛋白(t=2.58,0.028)、降钙素原(t=16.09,P<0.001)、白细胞介素-6(t=7.88,P=0.032)升高、术前清洁中段尿细菌培养阳性(χ^2=21.10,P<0.001)、术前/术后2 h血WBC比>1(t=4.51,P=0.001)、qSOFA阳性(χ^2=502.10,P<0.001)与术后尿脓毒血症发生有关。将qSOFA阳性且术前/术后2 h血WBC比>1的患者定义为尿脓毒血症高危患者。单独使用qSOFA的受试者工作特征曲线下面积(AUC)为0.98,阳性预测值为21.7%;单独使用术前/术后2 h血WBC比的AUC为0.98,特异性为60.0%,阳性预测值为38.5%;qSOFA联合术前/术后2 h血WBC比的AUC为1.00,特异性为98.3%,阳性预测值为93.8%,与前两者相比其预测效力明显提高。结论qSOFA阳性联合术前/术后2 h血WBC比>1可以在术后2 h早期、快速、准确地预测输尿管软镜碎石取石术后尿脓毒血症的发生。
Objective To discover the efficacy of the combination of preoperative/2 hours postoperative blood WBC count ratio and qSOFA to predict the urosepsis after flexible ureteroscopic lithotripsy.Methods Retrospectively analyze the patients’information from September 2015 to July 2018.In total,2364 patients who underwent the flexible ureteroscopic lithotripsy procedure were enrolled in the study.Patients gender(male:1463,female:751),age(54.9±14.0)years,BMI(23.9±2.8)kg/m^2,stone size(10.8±6.2)mm,side(left:1305,right:1018,both sides:41),preoperative body temperature(36.8±0.4)℃,blood glucose level(5.7±1.5)mmol/L,WBC(7.4±4.6)×10^9/L,neutrophil percentage 0.62±0.11,C reactive protein(20.1±59.3)mg/L,procalcitonin(1.6±11.8)μg/L,interleukin-6(11.3±32.9)pg/ml.Results The operative time was(39.3±23.0)min.The 2 hours postoperative WBC count was(6.7±2.9)×10^9/L,neutrophil percentage was 0.70±0.12.qSOFA was positive for 69 cases and negative for 2295 cases.15(0.6%)patients developed urosepsis.qSOFA positive patients were 15 in urosepsis group and 54 in normal group.The preoperative/2 hours postoperative blood WBC count ratio was 2.5±1.6 for urosepsis group and 0.7±0.2 for normal group.Univariate analysis showed that female patients(χ^2=16.20,P<0.001),large size of stones(t=2.14,P=0.050),high preoperative blood WBC(t=2.51,P=0.025),neutrophil percentage(t=2.90,P=0.012),C reactive protein(t=2.58,P=0.028),procalcitonin(t=16.09,P<0.001)and interleukin-6(t=7.88,P=0.032),positive preoperative mid-stream sample of urine culture(χ^2=21.10,P<0.001),preoperative/2 hours postoperative blood WBC count ratio>1(t=4.51,P=0.001)and qSOFA positive(χ^2=502.10,P<0.001)were recognized as statistically significant.Patients whose qSOFA was positive as well as preoperative/2 hours postoperative blood WBC count ratio>1 were diagnosed high-risk urosepsis patients.The efficacy of the combining of qSOFA and preoperative/2 hours postoperative blood WBC ratio>1 were higher than using separately.When using qSOFA alone,the area under the receiver operating characteristic curve was 0.98 but the positive prediction value was 21.7%.When using preoperative/2 hours postoperative blood WBC ratio alone,AUROC was 0.98,specificity was 60.0%and positive prediction value is 38.5%.Both indicate that the false positive rates were high.And for combining model,the area under the receiver operating characteristic curve was 1.00,specificity was 98.3%and the positive prediction value was 93.8%.It had a much higher efficacy which was a 2-hour-quick,sufficient and reliable indicator for diagnosing urosepsis.Conclusions The combination of qSOFA positive and preoperative/2 hours postoperative blood WBC count ratio>1 could quickly and accurately predict the urosepsis after flexible ureteroscopic lithotripsy.
作者
邵怡
鲁军
郑军华
Shao Yi;Lu Jun;Zheng Junhua(Department of Urology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第4期282-286,共5页
Chinese Journal of Urology
基金
申康适宜技术联合开发推广应用项目(SHDC12016226)
上海市科委生物医药领域科技支撑项目(19441909400)。
关键词
尿路结石
输尿管软镜碎石取石术
尿脓毒血症
快速序贯器官衰竭评分
Urinary calculi
Flexible ureteroscopic lithotripsy
Urosepsis
Quick sepsis related organ failure assessment(qSOFA)
