Design and internal validation of S.I.C.K.: a novel nomogram predicting infectious and hemorrhagic events after percutaneous nephrolithotomy.

Abstract

BACKGROUND:

Hemorrhagic and infectious events represent severe complications after percutaneous nephrolithotomy (PCNLs). Existing nephrolithometric nomograms have been introduced but their reliability in predicting complications is debated. We present a newly designed nomogram with intention to predict hemorrhagic/infectious events after PCNLs.

METHODS:

We conducted a multicentric prospective study on adult patients undergoing standard (24 Fr) or mini (18 Fr) PCNL. Dataset was derived from previous RCT, where patients have been assigned to mini-PCNL or standard-PCNL to treat renal stones up to 40 mm. Aim of the study was to identify preoperative risk factors for early postoperative infectious/hemorrhagic complications including fever, septic shock, transfusion or angioembolization.

RESULTS:

A total of 1980 patients were finally included. 992 patients (50.1%) received mini-PCNL and 848 standard PCNL (49.9%). The overall SFR was 86.1% with a mean maximum stone diameter of 29 mm (SD 25.0-35.0). 178 patients (8.9%) had fever,14 (0.7%) urosepsis, 24 patients (1.2%) required transfusion and 18 (0.9%) angioembolization. The overall complication was (11.7%). After multivariable analysis, the included elements in the nomogram were age (P=0.041), BMI (P=0.018), maximum stone diameter (P<0.001), preoperative hemoglobin (P=0.005), type 1/2 diabetes (P=0.05), eGFR<30 (P=0.0032), hypertension (>135/85 mmHg, P=0.001), previous PCNL or pyelo/nephrolithotomy (P=0.0018), severe hydronephrosis (P=0.002). After internal validation, the AUC of the model was 0.73.

CONCLUSIONS:

This is the first nomogram predicting infections and bleedings after PCNLs, it shows a good accuracy and can support clinicians in their patients' peri-operative workout and management.

• Authors: Giorgio Mazzon, Caterina Gregorio, Jiehui Zhong, Chao Cai, Nicola Pavan, Wen Zhong, Simon Choong, Guohua Zeng
• Journal: Minerva urology and nephrology (Minerva Urol Nephrol) Vol. 75 Issue 5 Pg. 625-633 (Oct 2023) ISSN: 2724-6442 [Electronic] Italy
• PMID: 37436027 (Publication Type: Journal Article)

Topics

• Adult
• Humans
• Nephrolithotomy, Percutaneous (adverse effects)
• Nomograms
• Treatment Outcome
• Prospective Studies
• Reproducibility of Results
• Kidney Calculi (surgery)
• Communicable Diseases (etiology)
• Hemorrhage (diagnosis, etiology)