The mayo adhesive probability score predicts postoperative fever and sepsis in retrograde intrarenal surgery
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Published on: February 15, 2022
Tsung-Yi Hsieh1, Shang-Jen Chang1, Jeff Shih-Chieh Chueh1
1Department of Urology, National Taiwan University Hospital, 7 Chung Shan S. Road (Zhongshan S. Road), Zhongzheng Dist, Taipei, 100225, Taiwan (R.O.C.).
Abstract:
Infectious complications are among the most common and potentially life-threatening morbidities of retrograde intrarenal surgery (RIRS). Few predictive tools on these complications include radiological signs. The Mayo adhesive probability (MAP) score is an image-based scoring system that incorporates two radiological signs: perinephric fat stranding and perinephric fat thickness. Previous studies have suggested an association between these signs and febrile urinary tract infection (UTI) following lithotripsy. This study aimed to evaluate the predictive factors, including the MAP score, for post-RIRS fever and sepsis. A total of 260 patients who underwent 306 RIRS between October 2019 to December 2023 due to renal or upper ureteral stones were included in this retrospective study. Patient demographics, perioperative characteristics, stone factors, radiological signs, and MAP scores were recorded. Multivariate logistic regression analysis was used to evaluate the risk factors associated with postoperative fever and sepsis. Postoperative fever and sepsis occurred in 20.8% and 8.5% of the patients, respectively. On multivariate analysis, female gender, history of recurrent UTI, larger maximal stone diameter, and higher MAP score were independent risk factors for postoperative fever and sepsis. Identifying the risk factors for post-RIRS infectious complications is imperative to providing the proper perioperative management. The MAP score is a promising, easily calculated, image-based scoring system that predicts post-RIRS fever and sepsis.
Insights
The Mayo Adhesive Probability (MAP) score can help predict infectious complications like fever and sepsis after retrograde intrarenal surgery (RIRS). Higher MAP scores, female gender, recurrent UTIs, and larger stones increase risk.
Area of Science:
- Urology
- Infectious Diseases
- Medical Imaging
Background:
- Infectious complications are common and serious risks following retrograde intrarenal surgery (RIRS).
- Predictive tools for these complications, especially those using radiological signs, are limited.
- The Mayo Adhesive Probability (MAP) score, based on perinephric fat stranding and thickness, has shown potential in predicting febrile urinary tract infections after lithotripsy.
Purpose of the Study:
- To evaluate predictive factors for post-RIRS fever and sepsis.
- To assess the utility of the Mayo Adhesive Probability (MAP) score in predicting these infectious complications.
Main Methods:
- Retrospective study of 260 patients (306 RIRS procedures) for renal or upper ureteral stones.
- Data collected included demographics, perioperative factors, stone characteristics, radiological signs, and MAP scores.
- Multivariate logistic regression analysis identified independent risk factors for postoperative fever and sepsis.
Main Results:
- Postoperative fever and sepsis occurred in 20.8% and 8.5% of patients, respectively.
- Independent risk factors for fever and sepsis included female gender, history of recurrent urinary tract infection (UTI), larger maximal stone diameter, and higher MAP score.
- The MAP score demonstrated a significant association with infectious complications.
Conclusions:
- Identifying risk factors for post-RIRS infectious complications is crucial for optimizing perioperative management.
- The MAP score is a valuable, easily calculable, image-based tool for predicting fever and sepsis after RIRS.
- Further research may validate the MAP score for routine clinical use in risk stratification.
