Nomogram and scoring system for preoperative prediction the risk of systemic inflammatory response syndrome in patients undergoing one-stage flexible ureteroscopy lithotripsy

doi:10.21203/rs.3.rs-5260972/v1

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Nomogram and scoring system for preoperative prediction the risk of systemic inflammatory response syndrome in patients undergoing one-stage flexible ureteroscopy lithotripsy

https://doi.org/10.21203/rs.3.rs-5260972/v1

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Objectives To develop an effective predictive tool for preoperative prediction the risk of systemic inflammatory response syndrome (SIRS) in one-stage flexible ureteroscopic lithotripsy (FURL).

Materials and methods A total of 340 patients with upper urinary tract stone (UUTS) who underwent one-stage FURL from April 2021 to May 2024 were analyzed retrospectively. We used least absolute shrinkage and selection regression and multivariate logistic regression analysis to screen out independent risk factors and then developed a nomogram. Concordance index (C-index), receiver operating characteristic curve and calibration curve were used to internal evaluated the predictive ability. Decision curve analysis (DCA) was used to test the clinical serviceability of the nomogram. We further evaluated the risk of SIRS in one-stage FURL based on the influence of available variables.

Results: Age, urinary white blood cells, urine bacterial culture and systemic immune-inflammation index (SII) were combined to establish nomogram for prediction the risk of SIRS in one-stage FURL. The SII had the highest odds ratio (OR = 30.356) to SIRS. The C-index (0.964, 95%CI = 0.932–0.996), area under curve (0.935), and calibration curve demonstrated the favourable predictive ability of nomogram prediction. DCA curve presented almost all patients in this study were suitable for this nomogram. We further developed a scoring system and classified the risk of SIRS into four grades.

Conclusion The established nomogram and risk scoring system have favourable predictive ability and clinical serviceability to personalize predict the SIRS risk in UUTS patients undergoing one-stage FURL. The proposed tool may help clinicians select effective treatment for UUTS patients.

ureteroscopy lithotripsy

upper urinary tract stone

systemic inflammatory response syndrome

nomogram

systemic immune-inflammation index

infection prevention

Upper urinary tract stone (UUTS), one of the most common diseases in urology, with an incidence rate of about 8.8% in the United States, and approximately 25% patients with UUTS require surgical treatment [1]. Flexible ureteroscopy lithotripsy (FURL) is widely used to treat UUTS with a diameter of less than 2 cm due to its advantages of less trauma and faster recovery than percutaneous nephrolithotomy (PCNL) and open surgery [2]. The standard treatment for FURL is to place a ureteral stent in first stage and perform lithotripsy in the second. Preoperative stent placement before FURL has shorter surgical time, higher stone-free rate and less complications than those without ureteral stents insertion [3]. However, two-stage FURL prolongs the hospitalization time and increases the economic burden of patients. In recent years, one-stage FURL has shown good lithotripsy performance and has been widely used in clinical practice [4, 5]. Sepsis is one of the most serious complications of FURL, and systemic inflammatory response syndrome (SIRS) is considered to be the early manifestation of sepsis [3]. Evaluating whether a patient develops SIRS during and after surgery is one of the most important factors in determining whether a ureteral stent should be placed before FURL. Therefore, this study aimed to develop an effective prediction tool for preoperative prediction the risk of SIRS for one-stage FURL based on the individual situation and routine laboratory results of UUTS patients.

Study Population

We selected patients with UUTS who underwent one-stage FURL in the Department of Urology, Xuancheng People's Hospital from April 2021 to May 2024 as the study objects. We set inclusion criteria in this study: (a) The presence of UUTC was confirmed by CT in all patients; (b) All patient was over 18 years old and had no nephrostomy tube or ureteral stent; (c) The study population were suffered with unilateral UUTC, mainly ureteral calculi, and had no infection other than urinary tract; (d) Patients with severe cardiopulmonary dysfunction, abnormal coagulation function, and history of mental disease, blood system disease, immune system disease, abnormal splenic disease and malignant tumor were excluded; (e) None of the patients had taken immunosuppressants, hormones, and antiplatelet coagulants in the past month; (f) We excluded patients with isolated kidney, polycystic kidney, horseshoe kidney, uremia, and preoperative SIRS response; (g) The study population did not include pregnant women or patients with blood transfusions or severe bleeding in nearly one year. This study was approved by the ethics committee and obtained informed consent from all patients.

Data Acquisition

We obtained the available information of UUTS patients including age, gender, height,weight, stone site, stone size, diabetes, hydronephrosis, neutrophils, lymphocytes, platelet, blood creatinine, urinary white blood cells (WBC), urine bacterial culture, ureteral access sheath and surgery time. All surgeries were performed by the same medical team. If the patient's urine WBC 2+/ 3 + or urine culture was positive, administered second-generation cephalosporin or sensitive antibiotic for anti-inflammatory treatment 2 days before surgery. All patients were used second-generation cephalosporin or sensitive antibiotic 30 minutes before FURL to prevent infection. Mild hydronephrosis indicated a separation of the renal pelvis less than 2cm, while moderate/ severe hydronephrosis indicated a separation of the renal pelvis greater than 2cm. Body mass index (BMI) value was calculated by height and weight. Estimated glomerular filtration rate (EGFR) value was counted by gender, age, and blood creatinine value. Systemic immune-inflammation index (SII) was calculated by blood neutrophils, lymphocytes and platelet. One-stage FURL indicated patient received FURL without preoperative ureteral stent placement. Two-stage FURL indicated patient underwent ureteral stent implantation before FURL. All examination information of the patients was preoperative results. SIRS positivity is defined as meeting at least two of the following criteria: body temperature more than 38.5℃ or less than 36℃; Heart rate more than 90 beats per minute; Respiratory rate more than 20 times per minute or PaCO2 less than 32 mmHg; Peripheral blood white blood cells more than 12*10^9/ L or less than 4*10^9/ L, or immature granulocytes more than 10% [2].

Statistical analysis

The available analysis variables included age, gender, BMI value, diabetes, stone site, stone size, hydronephrosis, urinary WBC, urine bacterial culture, EGFR value, SII value, ureteral access sheath, and surgery time. We used least absolute shrinkage and selection (LASSO) regression to select predictive factors with non zero coefficients.

We used multivariate logistic regression analysis to screen out independent risk factors with P-value less than 0.05. Combined with independent risk factors, nomogram was established to personalize predict the risk of SIRS in one-stage FURL. The predictive ability of the nomogram were evaluate by concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curve. We used decision curve analysis (DCA) to test the clinical serviceability of the nomogram by quantifying the benefit under different threshold probabilities. Based on the results of each variable subgroup in nomogram, we developed a SIRS scoring system by mathematical calculation. We further divided the risk of SIRS into four grades based on the score and the number of patients, and compared the risk of SIRS in patients at different grades. All statistical analyses and charts were conducted by using R software (version 4.4.1), and two-tailed P value < 0.05 was considered statistically significant.

Patients data

A total of 340 UUTS patients underwent one-stage FURL were selected in this study, among which 31 patients (9.12%) developed SIRS. We compared age, gender, BMI value, diabetes, stone site, stone size, hydronephrosis, urinary WBC, urine bacterial culture, EGFR value, SII value, ureteral access sheath, and surgery time between non-SIRS group and SIRS group. We listed the baseline characteristics of two groups in Table 1.

Table 1

Baseline characteristics of study cohort (n = 340).
Characteristics	Non-SIRS group (n = 309)	SIRS group (n = 31)	χ² value	P value
Characteristics	N (%)	N (%)	χ² value	P value
Gender			6.200	0.013
Male	217 (70.23%)	15 (48.39%)
Female	92 (29.77%)	16 (51.61%)
Age (years)			3.679	0.055
<=60	261 (84.47%)	22 (70.97%)
> 60	48 (15.53%)	9 (29.03%)
Stone site			3.825	0.050
Left	173 (55.99%)	23 (74.19%)
Right	136 (44.01%)	8 (25.81%)
Stone size (cm)			0.763	0.382
< 0.8	155 (50.16%)	13 (41.94%)
>=0.8	154 (49.84%)	18 (58.06%)
Ureteral access sheath			0.295	0.863
F10-12	89 (28.80%)	8 (25.81%)
F11-13	115 (37.22%)	11 (35.48%)
F12-14	105 (33.98%)	12 (38.71%)
Hydronephrosis			0.698	0.404
Mild	239 (77.35%)	26 (83.87%)
Moderate or severe	70 (22.65%)	5 (16.13%)
Urinary white blood cell			79.226	< 0.001
None or weakly positive	200 (64.72%)	7 (22.58%)
1 + or 2+	95 (30.75%)	8 (25.81%)
3+	14 (4.53%)	16 (51.61%)
Urine bacterial culture			57.741	< 0.001
None	303 (98.06%)	21 (67.74%)
Yes	6 (1.94%)	10 (32.26%)
Diabetes			0.141	0.708
None	285 (92.23%)	28 (90.32%)
Yes	24 (7.77%)	3 (9.68%)
Surgery time (hours)			5.268	0.022
< 1	267 (86.41%)	22 (70.97%)
>= 1	42 (13.59%)	9 (29.03%)
BMI value (kg/m^2)			0.078	0.780
< 22.9	102 (33.01%)	11 (35.48%)
>= 22.9	207 (66.99%)	20 (64.52%)
EGFR (ml/min/1.73m^2)			2.397	0.122
< 90	125 (40.45%)	17 (54.84%)
>= 90	184 (59.55%)	14 (45.16%)
SII value			141.436	< 0.001
< 700	225 (72.82%)	1 (3.23%)
700 ~ 1300	67 (21.68%)	6 (19.35%)
> 1300	17 (5.50%)	24 (77.42%)
Note: χ² is chi-square. Abbreviations: EGFR = estimated glomerular filtration rate; BMI = Body mass index; SII = systemic immune-inflammation index.

Independent risk factors

The feature selection of LASSO regression showed 13 features were reduced to six potential predictors (Fig. 1), including age, stone site, hydronephrosis, urinary WBC, urine bacterial culture and SII value. Those non-zero coefficient predictors were further analyzed by using multivariate logistic regression analysis, and variables with P values less than 0.05 were considered independent risk factors. The independent risk factors including age, urinary WBC, urine bacterial culture and SII value, and SII had the highest odds ratio (OR) (value = 30.356; 95%CI = 10.215–142.17) to SIRS, followed by urine bacterial culture (Table 2).

Table 2

Multivariate logistic regression analysis of prediction factors for study cohort.
Characteristics	β	S.E	Odds ratio (95% CI)	P value
Age	1.691	0.760	5.423 (1.253–25.971)	0.026
Stone site	-0.787	0.727	0.455 (0.099–1.796)	0.279
Hydronephrosis	-1.667	1.119	0.189 (0.016–1.418)	0.136
Urinary white blood cell	1.943	0.502	6.979 (2.853–21.063)	< 0.001
Urine bacterial culture	2.711	1.278	15.037 (1.456-227.307)	0.034
SII	3.413	0.656	30.356 (10.215–142.17)	< 0.001
Note: β is the regression coefficient. S.E is standard error. Abbreviations: CI = confidence interval; SII = systemic immune-inflammation index.

3.3 Establishment and validation nomogram

The independent risk factors age, urinary WBC, urine bacterial culture and SII value

were combined to establish nomogram for personalize prediction the risk of SIRS in one-stage FURL (Fig. 2). The C-index value (0.964, 95%CI = 0.932–0.996), area under curve (AUC, value = 0.935) were close to perfect. The calibration curves of the nonadherence nomogram demonstrated the favourable predictive ability to predict the risk of SIRS in one-stage FURL (Fig. 3). The DCA curve presented that almost all patients in this study were suitable for this nomogram, demonstrating the clinical effectiveness of our prediction model (Fig. 4).

Risk scoring system for SIRS

Combining the subgroup scores displayed in the nomogram, we established a risk scoring system to evaluate the risk of SIRS for one-stage FURL. The risk scoring system had a total of 100 points, and the higher the score indicated the greater risk of SIRS in one-stage FURL (Table 3). We classified the risk of developing SIRS in one-stage FURL into four grades based on the scores of each subgroup and the number of patients with UUTC. The incidence and risk multiples of SIRS for each grade were shown in Table 4.

Table 3

Scores of each subgroup in the risk scoring system.
Characteristics	Points	Characteristics	Points
Age (years)		Urine bacterial culture
<= 60	0	Negative	0
> 60	10	Positive	17
Urinary white blood cell		SII value
None/ weakly positive	0	<= 700	0
1+/ 2+	13	700 ~ 1300	24
3+	26	> 1300	47
Abbreviations: SII = systemic immune-inflammation index.

Table 4

The comparison of each grade in the risk scoring system.
Grade	Points	Number (%)	Number of patients with SIRS	Incidence rate (%)	Risk multiples
I	0–20	202 (59.41%)	1	0.50%	0.054
II	21–40	79 (23.24%)	1	1.267%	0.134
III	41–55	30 (8.82%)	5	16.67%	1.828
IV	56 ~ 100	29 (8.53%)	24	82.76%	9.077

In this study, we collected 340 UUTS patients who received one-stage FURL, of which 31 patients (9.12%) developed SIRS. Previous study reported the incidence of SIRS during and after FURL was 6.7–20.7% [6]. Sepsis is the most serious complication of FURL, which can lead to septic shock and even death [7]. Levy et al. gathered statistic on 25375 sepsis patients, including 18766 in the United States and 6609 in Europe, with adjusted mortality rates of 32.3% and 31.3%, respectively [8].

Patients who received one-stage FULR had a higher risk of developing SIRS compared to those who received two-stages FULR [3]. Thus, it is important for urologists to manage the risk of SIRS in FURL through general preoperative examinations and convenient tools.

In this study, we chose SIRS as an indicator to reflect urinary tract infections in UUTS patients. SIRS is a widely recognized marker of systemic inflammation and is considered to be an early manifestation of sepsis [9–11]. Some scholars had used other methods to predict sepsis early, such as quick sequential organ failure assessment (qSOFA) predicting sepsis based on changes in respiratory rate, systolic blood pressure, and mental state, but its effectiveness was not satisfactory [12–13]. Norwegian scholars conducted a statistical analysis of 1535 infected patients, of which 108 patients had sepsis, but only 33 (30.1%) met the qSOFA criteria, and among the 26 patients who died within 7 days, only 4 (15.4%) had a qSOFA score > = 2 [12]. Some other diseases may cause false positive of qSOFA, such as cardiac embolism, respiratory distress syndrome, severe trauma, anaphylactic shock. Due to the low sensitivity of qSOFA to sepsis, the international sepsis and septic shock management guidelines strongly recommend not using it as a single screening tool, and pointed out that SIRS judges sepsis levels higher than qSOFA, blood lactate, and other indicators [13].

The variables in our study were based on routine preoperative examinations of patients with UUTS, and the result showed that age, urinary WBC, urine bacterial culture and SII value were the independent risk factor for SIRS. Compared with young UUTS patients, elderly patients have lower immune function and more potential diseases, which may lead to a higher risk of developing SIRS. In our study, using urine WBC 3 + predicted SIRS with a sensitivity of 0.53 and a specificity of 0.95, and the sensitivity and specificity of SIRS predicted using urine bacterial culture were 0.63 and 0.94, respectively. Previous studies based on multiple logistic regression analysis had found that urine WBC positivity, urine bacterial culture positivity, and urine nitrite positivity were independent risk factors for inducing fever and SIRS in patients with UUTC [1, 14]. Nitrite is usually not present in normal urine. Bacteria in urine, especially gram negative bacteria, can convert nitrate into nitrite. However, only 6 patients with urinary nitrite positive patients were included in this study, resulting in urinary nitrite not being included in the analysis. Our results showed that SII had the highest OR (30.356) for developing SIRS in UUTS patients undergoing one-stage FURL. The sensitivity and specificity of predicting SIRS using urine SII > 1300 were 0.59 and 0.98, respectively. SII had been proven to be a promising prognostic indicator for evaluating the development of various inflammatory diseases and the prognosis of various malignant tumors [15–18]. Preoperative SII had also been proven to be an important indicator for evaluating the risk of infection in patients undergoing various surgeries, such as knee arthroplasty, cardiac stent implantation, lung surgery, etc [19–21]. In the field of urological lithotripsy, Peng et al. investigated the value of preoperative SII in predicting SIRS in PCNL and found that SII had better predictive effect than traditional inflammatory predictors [22]. Infectious UUTS is more prone to SIRS response, and elevated neutrophils and decreased lymphocyte may secrete inflammatory mediators that may accelerate stone formation. Platelet activation can release vascular permeability factors by releasing 5-hydroxytryptamine from alpha particles and dense particles, enhancing vascular permeability, promoting chemotactic white blood cells, and participating in the inflammatory process [22]. However, we had not found any studies on preoperative SII predicting infection in the field of FURL.

Nomogram, a statistical tool that visualizes multiple independent risk factors, is is widely used to assess the risk of disease occurrence and prognosis [23–24]. Compared with the previous nomogram predicting SIRS risk for patients undergoing FURL [25–26], our nomogram model had the following differences. Firstly, the subjects of this study were all patients receiving one-stage FURL. The focus of this study was to evaluate the risk of SIRS in UUTS patients who without ureteral stents implanted before FURL, and to facilitate better selection of surgical methods in clinical practice. Second, we evaluated for the first time the effect of SII on the development of SIRS in patients undergoing one-stage FURL. Third, we had established a risk scoring system of developing SIRS in one-stage FURL for the first time and classified the risk into four grades. In our risk scoring system, SII > 1300 had the highest score of 47. Our risk scoring system showed grade IV with points 55 to 100, and the risk multiple for developing SIRS in grade IV was 9.077 compared with the general population. We strongly recommend that UUTC patients with a preoperative score of grade four should undergo two-stage FURL. In addition, we strongly recommend that a ureteral stent should be placed before FURL in patients with SII greater than 1300 and one of the following: age>60 years, urinary white blood cell 1+/2+/3+, or Urine bacterial culture positive.

However, there are still some limitations in our study. First, the limitation on the number of patients may introduce bias into our results. Second, some variables, such as gender, diabetes, stone size, ureteral access sheath and surgery time, had no statistical significance in this study, but had been confirmed to have an impact on SIRS risk in other studies [6, 27–28]. Finally, this study is a retrospective analysis of a single medical institution and requires further prospective studies and external validation to validate our results.

This study established a convenient nomogram with age, urine WBC, urine bacterial culture, and SII value to preoperative predict the risk of SIRS for one-stage FURL. We internally verified that nomogram has favourable predictive ability and clinical serviceability. We first proposed a risk scoring system for SIRS in patients undergoing one-stage FURL, and SII is the most relevant risk factor for SIRS. UUTC patients with a preoperative score of grade four should undergo two-stage FURL. The proposed tool could help clinicians select effective treatment for UUTS patients.

UUTS= upper urinary tract stone; FURL= flexible ureteroscopy lithotripsy; PCNL= percutaneous nephrolithotomy; SIRS= systemic inflammatory response syndrome; WBC= urinary white blood cells; BMI= body mass index; EGFR= estimated glomerular filtration rate; SII= systemic immune-inflammation index; LASSO= least absolute shrinkage and selection; C-index= concordance index; ROC= receiver operating characteristic; DCA= decision curve analysis; OR= odds ratio; CI= confidence interval; qSOFA= quick sequential organ failure assessment.

Author contributions YZ: data collection, data analysis and manuscript writing. LZ: analysis validation and manuscript editing. HZ：data collection and analysis. RZ: data collection and critical revision. YD: protocol and project development. ZW: data collection and manuscript writing. CL: study design and manuscript editing.

Funding Not applicable.

Conflict of interest All authors have no conflict of interest and approved the submitted version.

Ethics approval This study was approved by the ethics committee and obtained informed consent from all patients.

Ma YC, Jian ZY, Li H, Wang KJ (2021) Preoperative urine nitrite versus urine culture for predicting postoperative fever following flexible ureteroscopic lithotripsy: a propensity score matching analysis. World J Urol 39(3):897–905
Ma C, Lu J, Zhu YY, Huo YJ, Xia SJ, Shao Y (2021) Systemic Inflammatory Response Syndrome Combined with Pre- and Postoperative White Blood Cell Ratio Is a Better Criterion to Identify Septic Shock Patients After Flexible Ureteroscopic Lithotripsy. J Endourol 35(7):973–978
Assimos D, Crisci A, Culkin D, Xue W, Roelofs A, Duvdevani M et al (2016) Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study. BJU Int 117(4):648–654
Huang WN, Huang HL, Wang YH, Chen WX, Deng H, Zhong MZ (2024) Application of 11/13Fr suctioning ureteral access sheath and 8.55Fr single-use digital flexible ureteroscope in one-stage flexible ureteroscopic lithotripsy: an initial experience of 900 cases. Urolithiasis 52(1):112
Pan Y, Chen H, Chen HL, Jin XX, Zhu YX, Chen G (2021) The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1–3 cm renal stones and risk factors of renal function changes. Ren Fail 43(1):264–272
Mi QW, Meng XJ, Meng LH, Chen D, Fang SW (2020) Risk Factors for Systemic Inflammatory Response Syndrome Induced by Flexible Ureteroscope Combined with Holmium Laser Lithotripsy. Biomed Res Int 6842479
Wang LB, Yu XZ, Qiu ZZ, Liu PY, Tian W, He W et al (2024) Influence of preoperative urine culture and bacterial species on urogenital sepsis after ureteral flexible lithotripsy in patients with upper urinary tract stones. Front Med (Lausanne) 11:1393734
Levy M, Artigas A, Phillips G, Rhodes A, Beale R, Osborn T et al (2012) Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis 12(12):919–924
Schefzik R, Hahn B, Schneider LV (2023) Dissecting contributions of individual systemic inflammatory response syndrome criteria from a prospective algorithm to the prediction and diagnosis of sepsis in a polytrauma cohort. Front Med (Lausanne) 31(10):1227031
Ye JJ, Hu XD, Wang ZW, Li R, Gan L, Zhang MW et al (2023) The role of mtDAMPs in the trauma-induced systemic inflammatory response syndrome. Front Immunol 18(14):1164187
Wu WJ, Zhang D, Jin TT, Lu TY, Zhou FH (2023) Progress in the study of biomarkers for early prediction of systemic inflammatory response syndrome after percutaneous nephrolithotomy. Front Immunol 30(14):1142346
Askim A, Moser F, Gustad L, Stene H, Gundersen M, Åsvold B et al (2017) Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department. Scand J Trauma Resusc Emerg Med 25(1):56
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C et al (2021) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 47(11):1181–1247
Xu P, Zhang SK, Zhang YY, Zeng T, Chen D, Wu WZ et al (2021) Enhanced Antibiotic Treatment Based on Positive Urine Dipstick Infection Test Before Percutaneous Nephrolithotomy Did Not Prevent Postoperative Infection in Patients with Negative Urine Culture. J Endourol 35(12):1743–1749
Pricop M, Ancusa O, Talpos S, Urechescu H, Bumbu BA (2022) The Predictive Value of Systemic Immune-Inflammation Index and Symptom Severity Score for Sepsis and Systemic Inflammatory Response Syndrome in Odontogenic Infections. J Pers Med 12(12):2026
Staniewska E, Grudzien K, Stankiewicz M, Raczek ZK, Rembak SJ, Nowicka Z et al (2024) The Prognostic Value of the Systemic Immune-Inflammation Index (SII) and Red Cell Distribution Width (RDW) in Patients with Cervical Cancer Treated Using Radiotherapy. Cancers (Basel) 16(8):1542
Guo WC, Song YC, Sun Y, Du HS, Cai Y, You QQ et al (2022) Systemic immune-inflammation index is associated with diabetic kidney disease in Type 2 diabetes mellitus patients: Evidence from NHANES 2011–2018. Front Endocrinol (Lausanne) 6(13):1071465
Zhang HS, Lin J, Huang YF, Chen Y (2024) The Systemic Immune-Inflammation Index as an Independent Predictor of Survival in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma Undergoing Neoadjuvant Radiotherapy. J Inflamm Res 11(17):4575–4586
Telang S, Mayfield CK, Palmer R, Liu KC, Wier J, Hong K et al (2024) Preoperative Laboratory Values Predicting Periprosthetic Joint Infection in Morbidly Obese Patients Undergoing Total Hip or Knee Arthroplasty. J Bone Joint Surg Am 106(14):1317–1327
Xu PP, Cao Y, Ren RQ, Zhang S, Zhang C, Hao PP et al (2024) Usefulness of the Systemic Inflammation Response Index and the Systemic Immune Inflammation Index in Predicting Restenosis After Stent Implantation. J Inflamm Res 23(17):4941–4955
Miao HH, Ge DY, Wang QW, Zhou LL, Chen HS, Qin YB et al (2024) Predictive significance of systemic immune-inflammation index combined with prealbumin for postoperative pneumonia following lung resection surgery. BMC Pulm Med 24(1):277
Peng C, Li JL, Xu G, Jin J, Chen JJ, Pan SH (2021) Significance of preoperative systemic immune-inflammation (SII) in predicting postoperative systemic inflammatory response syndrome after percutaneous nephrolithotomy. Urolithiasis 49(6):513–519
Leon MD, Lundsberg LS, Culhane J, Zhang J, Son M, Reddy UM (2023) Fetal growth restriction and small for gestational age as predictors of neonatal morbidity: which growth nomogram to use? Am J Obstet Gynecol 229(6):678
Zhou Y, Lin CM, Zhu L, Zhang RT, Cheng L, Chang YY (2023) Nomograms and scoring system for forecasting overall and cancer-specific survival of patients with prostate cancer. Cancer Med 12(3):2600–2613
Sun JX, Xu JZ, Liu CQ, Xun Y, Lu JL, Xu MY (2022) A Novel Nomogram for Predicting Post-Operative Sepsis for Patients With Solitary, Unilateral and Proximal Ureteral Stones After Treatment Using Percutaneous Nephrolithotomy or Flexible Ureteroscopy. Front Surg 15(9):814293
Xuan ZJ, Yu ZK, Tan GB, Ding N, He HB, Yu SC et al (2022) Development and validation of a novel nomogram for predicting systemic inflammatory response syndrome's occurrence in patients undertaking flexible ureteroscopy. Transl Androl Urol 11(2):228–237
Giulioni C, Brocca C, Gauhar V, Somani BK, Chew BH, Traxe O et al (2023) Does age impact outcomes of retrograde intrarenal surgery in the elderly? Results from 366 patients from the FLEXible ureteroscopy outcomes registry (FLEXOR). Aging Clin Exp Res 35(11):2711–2719
Mohanty S, Kamolvit W, Scheffschick A, Björklund A, Tovi J, Espinosa A et al (2022) Diabetes downregulates the antimicrobial peptide psoriasin and increases E. coli burden in the urinary bladder. Nat Commun 13(1):4983

No competing interests reported.

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Nomogram and scoring system for preoperative prediction the risk of systemic inflammatory response syndrome in patients undergoing one-stage flexible ureteroscopy lithotripsy

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Abstract

Figures

Introduction

Materials and methods

Study Population

Data Acquisition

Statistical analysis

Results

Patients data

Independent risk factors

3.3 Establishment and validation nomogram

Risk scoring system for SIRS

Discussion

Conclusions

Abbreviations

Declarations

References

Additional Declarations

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