Risk Factors and Nomogram for Predicting Urosepsis Following Laparoscopic Urological Surgery and Its Association With...

This study aimed to investigate the incidence and risk factors of urosepsis following laparoscopic urological surgery, develop a predictive nomogram, and evaluate the association between postoperative urosepsis and acute kidney injury (AKI).

This retrospective analysis was performed on 426 consecutive patients who underwent laparoscopic urological surgery between March 2020 and August 2025. Patients were divided into a sepsis group (n = 42) and a non-sepsis group (n = 384) based on the occurrence of postoperative urosepsis. Demographics, disease and surgical characteristics, laboratory parameters, and the incidence of AKI were compared between the two group. Independent risk factors were identified using multivariable logistic regression and incorporated into a predictive nomogram. Model performance was assessed by receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA).

Postoperative urosepsis occurred in 9.86% (42/426) of patients, of whom 83.33% (35/42) had positive urine cultures. Independent risk factors included positive preoperative urine culture, prolonged operative time, elevated urinary heparin-binding protein (HBP), and elevated white blood cell (WBC) count (all p < 0.05). The nomogram achieved an area under the ROC curve of 0.812 (95% confidence interval [CI]: 0.739-0.885), sensitivity of 0.810, specificity of 0.677, accuracy of 0.690, good calibration (Hosmer-Lemeshow test, p = 0.388), and net clinical benefit on DCA. The incidence of AKI was higher in the sepsis group than in the non-sepsis group (30.95% vs. 6.25%, p < 0.05), with greater severity observed in the sepsis group. After adjustment for age, diabetes mellitus, intraoperative blood loss, and baseline creatinine, urosepsis remained an independent risk factor for AKI (odds ratio [OR] = 5.623, 95% CI: 2.847-11.106; p < 0.05).

Urosepsis after laparoscopic urological surgery is an independent risk factor for AKI. The developed nomogram, incorporating preoperative urine culture, operative time, urinary HBP, and WBC count, demonstrated good performance in identifying patients at high risk of postoperative urosepsis.