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Decreased hemoglobin as a quantifiable indicator of renal arterial embolization in post-percutaneous nephrolithotomy
Ruitu Ran1, Ruiyuan Zhang2, Ye Xie1
1Departments of Urinary Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China.
Insights
A significant decrease in hemoglobin (Hb) levels after percutaneous nephrolithotomy (PCNL) indicates the need for super-selective renal arterial embolization (SRAE). An adjusted Hb decrease of 3.45 g/dL is the optimal threshold for performing SRAE.
Area of Science:
- Urology
- Interventional Radiology
- Nephrology
Background:
- Post-percutaneous nephrolithotomy (PCNL) hemorrhage is a significant complication.
- Identifying reliable indicators for intervention, such as super-selective renal arterial embolization (SRAE), is crucial for patient management.
Purpose of the Study:
- To identify quantifiable indicators for post-PCNL renal arterial embolization.
- To establish an optimal threshold for SRAE based on post-operative hemorrhage indicators.
Main Methods:
- Retrospective review of 2043 patients undergoing PCNL.
- Comparison of patients with post-PCNL hemorrhage treated conservatively versus with SRAE.
- Univariable and multivariable logistic regression analyses, and ROC curve analysis to determine optimal cut-off values.
Main Results:
- 71 patients experienced post-PCNL hemorrhage, with 17 undergoing SRAE and 54 treated conservatively.
- Decreased hemoglobin (Hb) levels, hemorrhage type, and transfusion requirements were significant factors.
- Multivariable analysis identified decreased Hb as strongly associated with SRAE risk.
- An adjusted Hb decrease of 3.45 g/dL was determined as the optimal indicator for SRAE via ROC curve analysis (AUC = 0.925).
Conclusions:
- Decreased hemoglobin is a key indicator for considering SRAE after PCNL.
- SRAE should be performed when the adjusted decrease in Hb reaches or exceeds 3.45 g/dL, irrespective of other hemorrhage manifestations.
Abstract:
To determine quantifiable indicators for post-percutaneous nephrolithotomy (PCNL) renal arterial embolization. A total of 2043 patients who underwent PCNL from September 2012 to March 2018 were reviewed retrospectively. Post-operative hemorrhage patients were extracted and divided into two groups according to treatment methods (conservative methods or super-selective renal arterial embolization [SRAE]). Demographic characteristics and hemorrhage outcomes were compared between the two groups by univariable analysis. Multivariable logistic regression was used to reveal the association between hemorrhage outcome factors and SRAE. A receiver operating characteristic (ROC) curve was drawn to determine the optimized cut-off value for SRAE. We identified 71 patients who had post-PCNL hemorrhage. Seventeen and 54 patients comprised the SRAE and conservative groups, respectively. No significant differences in demographic characteristics were found between the two groups. Univariate analysis showed that the differences in decreased hemoglobin (Hb), hemorrhage types, and transfusion were significant between the two groups (p < 0.001). Multivariable analysis showed that the decreased Hb was closely associated with the risk of SRAE. The ROC curve showed that an adjusted Hb decrease of 3.45 g/dL was an optimum indicator (AUC = 0.925). Decreased Hb is an indicator for SRAE after PCNL. When the adjusted decrease in Hb is ≥ 3.45 g/dL, SRAE should be performed regardless of the manifestations of hemorrhage.
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