Risk factor analysis for septic shock in female patients after mini-percutaneous nephrolithotripsy

Septic shock after mini-percutaneous nephrolithotripsy (mini-PCNL) has a relatively low incidence rate but results in a high mortality rate. This study aimed to identify the risk factors for septic shock in female patients undergoing mini-PCNL and proposed appropriate strategies for its management.

Female patients receiving mini-PCNL from January 2021 to March 2025 were retrospectively analyzed. Variables covering age, surgical site, body mass index (BMI), hypertension, diabetes mellitus, history of immunosuppressive therapy or stone surgery, preoperative urinary tract infection, urine culture, preoperative serum creatinine, stone size, and operative time were examined. Univariate and multivariate logistic regression analyses were consecutively performed to identify independent risk factors.

A total of 920 female patients were included in this study, among whom 19 (2.07%) developed septic shock following mini-PCNL. Among the 19 patients with septic shock, 2 patients succumbed to multiple organ dysfunction syndrome following clinical deterioration. Univariate and multivariate analyses revealed the following independent risk factors: BMI ≥28 kg/m² [odds ratio (OR) =1.235; P=0.04], history of diabetes mellitus (OR =2.874; P<0.001), prior immunosuppressive agents (e.g., glucocorticoids, cyclosporine, polyclonal/monoclonal anti-lymphocyte antibodies, alkylating agents) (OR =1.815; P<0.001), and preoperative urinary tract infection (OR =1.217; P=0.047).

Septic shock in female patients following mini-PCNL is relatively rare but associated with a high mortality rate. Obesity, history of diabetes mellitus, prior use of immunosuppressive agents, and preoperative urinary tract infection were identified as independent risk factors for postoperative septic shock in this population. Therefore, adequate preoperative prophylactic use of antibiotics, strict control of blood glucose and stability of immune system disorder are strongly recommended before performing mini-PCNL in female patients.