Analysis of the Causes and Preventive Strategies of Urogenic Sepsis after Flexible Ureteroscopic Lithotripsy

Abstract

Objective. To explore the causes of urogenic sepsis in patients after flexible ureteroscopic lithotripsy and analyze the preventive strategies. Methods. A total of 240 patients who underwent flexible ureteroscopic lithotripsy in our hospital from January 2019 to June 2022 were selected and divided into 2 groups according to whether postoperative ureteral sepsis occurred. 24 cases occurred in the observation group. Logistics multivariate regression analysis was used to analyze the risk factors of urogenic sepsis after flexible ureteroscopic lithotripsy, and the serum albumin (ALB), the peripheral blood neutrophil-to-lymphocyte ratio (NLR), and the level of procalcitonin (PCT) were correlated, and the ROC curve was used to analyze the predictive value of each index for urosepsis. Results. Univariate analysis showed that there were differences in gender, age, diabetes, stone diameter, and urine culture ratio between the two groups ( $P<0.05$ ). The results of multivariate regression analysis showed that female, age ≥60 years, stone diameter >2.5 cm, and positive urine culture were the main influencing factors for the occurrence of urogenic sepsis. After operation, the ALB levels in the two groups were lower than those before operation, and the levels of NLR and PCT in the two groups were higher than those before operation; the ALB levels in the observation group were lower than those in the control group, and the NLR and PCT in the observation group were higher than those in the control group ( $P<0.05$ ). According to Spearman’s correlation analysis, ALB was negatively correlated with the occurrence of uremia ( $P<0.05$ ), r = −0.320, NLR and PCT were positively correlated with the occurrence of uremia ( $P<0.05$ ), r = 0.313, respectively, and 0.417; in addition, Pearson’s correlation analysis showed that ALB was negatively correlated with NLR and PCT in the two groups ( $P<0.05$ , r = −0.507, −0.605 in the control group, respectively, and r were −0.452 and −0.412 in the observation group). There was a positive correlation between NLR and PCT ( $P<0.05$ ), r = 0.840, and there was no correlation between NLR and PCT in the observation group ( $P>0.05$ ). According to the ROC curve analysis, the predictive value AUC of ALB, NLR, PCT and combined use were 0.808, 0.801, 0.901, and 0.925 ( $P<0.05$ ). Conclusion. Gender, age, stone diameter, and urine culture results are the main influencing factors for the occurrence of urinary sepsis. Therefore, preventive measures should be strengthened for this group of patients. In addition, the combined use of postoperative ALT, NLR, and PCT level tests can be better.