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The value of procalcitonin for predicting urosepsis after mini-percutaneous nephrolithotomy or flexible ureteroscopy

Minghui Liu1, Zewu Zhu1, Yu Cui1

  • 1Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.

World Journal of Urology
|October 6, 2021
PubMed
Abstract

Insights

Procalcitonin (PCT) effectively predicts Gram-negative urosepsis after urologic procedures. Elevated PCT levels indicate a higher risk, but it is not a reliable predictor for Gram-positive or fungal infections.

Area of Science:

  • Urology
  • Infectious Diseases
  • Biomarkers

Background:

  • Urosepsis is a serious complication following urologic procedures like mini-percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy (FURS).
  • Early identification of causative pathogens is crucial for effective treatment.
  • Procalcitonin (PCT) is investigated as a potential early biomarker for urosepsis.

Purpose of the Study:

  • To evaluate procalcitonin (PCT) as an early predictive biomarker for urosepsis.
  • To differentiate urosepsis caused by Gram-negative (GN) bacteria, Gram-positive (GP) bacteria, and fungi.
  • To assess PCT's value following mPCNL and FURS procedures.

Main Methods:

  • Retrospective analysis of 356 patients with positive preoperative urine cultures (UC) undergoing mPCNL or FURS.
  • Univariable and multivariable logistic regression analyses to identify predictors of urosepsis.
  • Development of a nomogram for predicting urosepsis risk.

Main Results:

  • Gram-negative bacteria were the predominant pathogens (74.4%), followed by Gram-positive bacteria (21.4%) and fungi (3.9%).
  • Postoperative PCT > 0.1 ng/mL, positive nitrite, and operative time > 90 min were independent predictors of GN urosepsis.
  • Stone burden > 800 mm² was the only independent risk factor for GP urosepsis, while PCT was not associated with GP or fungal urosepsis.

Conclusions:

  • Postoperative PCT > 0.1 ng/mL is a significant independent risk factor for urosepsis caused by Gram-negative bacteria after mPCNL and FURS.
  • PCT is not a reliable predictor for urosepsis originating from Gram-positive bacteria or fungal infections in this patient cohort.
Keywords:
Flexible ureteroscopyGram-negative bacteriaGram-positive bacteriaMini-percutaneous nephrolithotomyProcalcitonin

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