Intraoperative Urine Tests and STONE Score Predict Postoperative SIRS (Systemic Inflammatory Response Syndrome) After...

This study aimed to identify predictors of postoperative systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL) in patients with negative preoperative midstream urine culture (PMUC), and to assess the predictive value of intraoperative renal pelvic urine tests, urinary sediment examination, and the STONE score.

Clinical data were retrospectively collected from PMUC-negative patients with complex renal calculi who underwent first-stage single-tract PCNL at the First Affiliated Hospital of Fujian Medical University. Patients were classified into SIRS and non-SIRS groups according to the occurrence of postoperative SIRS within 72 hours. SIRS was used as an indicator of early postoperative systemic inflammatory response, as not all cases met Sepsis-3 criteria for organ dysfunction. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of postoperative SIRS. A nomogram was subsequently developed and assessed for calibration and discrimination.

A total of 126 patients (89 males and 37 females) were included, and 29 developed postoperative SIRS. Multivariate logistic regression identified intraoperative leukocyte esterase (LE) positivity (OR = 2.324, 95% CI 1.164-4.641, p = 0.017), elevated intraoperative white blood cell (WBC) count (OR = 5.855, 95% CI 1.209-28.357, p = 0.028), positive stone culture (OR = 15.929, 95% CI 1.792-141.600, p = 0.013), and higher STONE score (OR = 1.948, 95% CI 1.125-3.375, p < 0.017) as independent risk factors. The nomogram demonstrated good calibration (Hosmer-Lemeshow p > 0.05) and strong discriminative ability, with an AUC of 0.935.

Intraoperative leukocyte esterase, intraoperative white blood cell count, positive stone culture, and higher STONE score were independently associated with postoperative SIRS after first-stage PCNL in PMUC-negative patients. The nomogram may assist in early risk stratification in this population.