Development of a predictive nomogram for sepsis in patients with urolithiasis-related obstructive pyelonephritis

Development of a predictive nomogram for sepsis in patients with urolithiasis-related obstructive pyelonephritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development of a predictive nomogram for sepsis in patients with urolithiasis-related obstructive pyelonephritis Yi-Chun Tsai, Yu-Hsuan Huang, Kuang-Yu Niu, Hsin-Tzu Yeh, Sz-Wei Lu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4397502/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: In patients with urolithiasis-related obstructive pyelonephritis (UROP), sepsis represents a critical and concerning complication that can substantially increase the mortality rate. This study aimed to identify the risk factors for sepsis in UROP patients and to develop a predictive nomogram model. Methods: We analyzed data from 148 patients who met the UROP criteria and were admitted to Chang Gung Memorial Hospital between January 1, 2016, and December 31, 2021. The primary outcome evaluated was the incidence of sepsis, as defined by the most recent Sepsis-3 guidelines. To identify potential risk factors for sepsis, we employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression technique. Subsequently, we utilized multivariable logistic regression to construct the predictive model. Results: There were a total of 102 non-sepsis cases and 46 sepsis cases. The sepsis group showed significantly lower systolic blood pressure (p < 0.001), a higher heart rate (p = 0.002), a higher shock index (SI) (p < 0.001), a more prevalent history of diabetes mellitus (DM) (p = 0.015), and the mean hospital length of stay was significantly longer (p < 0.001). The laboratory results indicated a higher rate of positive blood culture in the sepsis group (60.9% vs 33.3%, p = 0.002), increased serum white blood cell counts (17.2 ± 10.9 103/uL vs 12.8 ± 6.4 103/uL, p = 0.014), a higher proportion of bandemia (26.1% vs 4.1%, p < 0.001), elevated CRP levels (19.9 ± 9.8 mg/dL vs 9.9 ± 9.9 mg/dL, p < 0.001), and a higher neutrophil to lymphocyte ratio (NLR) (23.6 ± 20.3 vs 12.9 ± 10.1, p < 0.001). Risk factors for sepsis in multivariable analysis were a history of DM (OR = 4.24, p = 0.007), SI (x10-1) (OR = 1.55, p < 0.001), CRP (mg/dL) (OR = 1.08, p = 0.005), and NLR (x10) (OR = 1.58, p = 0.007). Conclusions: Our study demonstrated that patients with UROP who have DM, higher SI, higher NLR, and elevated CRP levels are significantly more likely to develop sepsis. These insights may aid in risk stratification, and it is imperative that clinicians promptly initiate treatment for those identified as high risk. uolithiasis-related obstructive pyelonephritis sepsis nomogram Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Full Text Additional Declarations No competing interests reported. Tables 1-4 are available in the Supplementary Files section. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4397502","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":304200424,"identity":"55e8913f-618f-413c-be1c-8aa4a67c5447","order_by":0,"name":"Yi-Chun Tsai","email":"","orcid":"","institution":"Queen Mary University of London","correspondingAuthor":false,"prefix":"","firstName":"Yi-Chun","middleName":"","lastName":"Tsai","suffix":""},{"id":304200425,"identity":"005061e1-1f05-4be0-8443-0fd1961f4b3b","order_by":1,"name":"Yu-Hsuan Huang","email":"","orcid":"","institution":"Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu-Hsuan","middleName":"","lastName":"Huang","suffix":""},{"id":304200426,"identity":"e4836795-6978-4359-b11e-3f830151e994","order_by":2,"name":"Kuang-Yu Niu","email":"","orcid":"","institution":"Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kuang-Yu","middleName":"","lastName":"Niu","suffix":""},{"id":304200427,"identity":"27e674d9-8275-49fc-8fbd-d724765ad89c","order_by":3,"name":"Hsin-Tzu Yeh","email":"","orcid":"","institution":"Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hsin-Tzu","middleName":"","lastName":"Yeh","suffix":""},{"id":304200428,"identity":"44290053-ac35-4656-b61e-6c834c5b9b73","order_by":4,"name":"Sz-Wei Lu","email":"","orcid":"","institution":"Tri-Service General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sz-Wei","middleName":"","lastName":"Lu","suffix":""},{"id":304200429,"identity":"ef09cc66-770d-4b92-a7f0-edd9aeadadbd","order_by":5,"name":"Yu-Tai Lo","email":"","orcid":"","institution":"Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu-Tai","middleName":"","lastName":"Lo","suffix":""},{"id":304200430,"identity":"b4c05ce5-4706-409a-af4c-e714372f5437","order_by":6,"name":"Yu-Chen Tsai","email":"","orcid":"","institution":"Chang Gung Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu-Chen","middleName":"","lastName":"Tsai","suffix":""},{"id":304200431,"identity":"dcc88812-a7b1-42b0-8b80-6588bd425f51","order_by":7,"name":"Chen-Bin Chen","email":"","orcid":"","institution":"New Taipei Municipal Tucheng Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chen-Bin","middleName":"","lastName":"Chen","suffix":""},{"id":304200432,"identity":"ceab5d6a-2b11-4ba8-b0ba-30afd5fbbf0d","order_by":8,"name":"Chieh-Ching Yen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYDACCcYGZgaGAzwMDPwfDD4ABdjYidfCYFA4A6SFmaAWBgaQFhDT4DNIIwMhLfyzmxsfF9TckTHnX5C42ebXNnk+ZgbGDx9z8Fhy52Cz8Yxjz3gsZzw4bJzbd9uwjZmBWXLmNtxaDCQS26R5Gw7zGNw42Gac23ObEaiFjZkXv5b23xAth9l/W/bctidGSxszWMv5NgZjhh+3EwlqkbiR2CzNcwxkCw+DYW/D7eQ2ZsZmvH7hn5H+8DNPzWF7g/NnGAx+/LltO7+9+eCHj3i0INmXwMDA2AZiMTYQox5k3wEg8YdIxaNgFIyCUTCiAACNk1N/h5FqqAAAAABJRU5ErkJggg==","orcid":"","institution":"New Taipei Municipal Tucheng Hospital","correspondingAuthor":true,"prefix":"","firstName":"Chieh-Ching","middleName":"","lastName":"Yen","suffix":""}],"badges":[],"createdAt":"2024-05-10 01:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4397502/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4397502/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57035628,"identity":"98300b6f-ae64-47dc-9105-1596eaafebd4","added_by":"auto","created_at":"2024-05-23 18:34:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":274061,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of eligible patients. UROP: urolithiasis-related obstructive pyelonephritis\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/68d99b7bf75a5b06ad2ae2b4.png"},{"id":57035635,"identity":"87e2a09c-05e7-4e22-8f4e-38dd8ada9a63","added_by":"auto","created_at":"2024-05-23 18:34:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":103171,"visible":true,"origin":"","legend":"\u003cp\u003eMultivariable logistic regression analysis identifying predictors of sepsis in patients with urolithiasis-related obstructive pyelonephritis. OR: Odds ratio\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/eabe49096a599dbc93c32ba7.png"},{"id":57035636,"identity":"a2da0f31-3172-4b90-8f5d-6627a4b4180b","added_by":"auto","created_at":"2024-05-23 18:34:05","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":107451,"visible":true,"origin":"","legend":"\u003cp\u003eNomogram for estimating probability of sepsis. Identify predictor points for each subject variable on the top scale, sum them, and project the total onto the bottom scale to determine the sepsis probability.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/95b9a226b1296bf3228e2795.png"},{"id":57037092,"identity":"1575850c-9c4f-41cd-a47e-717c296c359b","added_by":"auto","created_at":"2024-05-23 18:42:05","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":217739,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Calibration curve for the sepsis nomogram. The X-axis depicts the predicted sepsis risk, while the Y-axis shows the actual diagnosed cases of sepsis. The diagonal dotted line illustrates a perfect prediction from an ideal model. The short-dashed line represents the nomogram's apparent prediction, with the solid line indicating the nomogram's performance after bias-correction through bootstrapping (B = 1000 repetitions). (B) Decision curve analysis for the nomogram. The X-axis displays the threshold probability, while the Y-axis quantifies the net benefit. The blue solid line represents the nomogram. The red line assumes that all subjects had sepsis, and the green line assumes that none of the subjects had sepsis.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/651589fe901874981dc25f15.png"},{"id":57035633,"identity":"182e32c3-8943-4fd9-9bb5-28ba6bda2ea2","added_by":"auto","created_at":"2024-05-23 18:34:05","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":122420,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the area under the curve (AUC) for the multivariable model and each selected variable\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/4d529d6b67e085f8d60a37c7.png"},{"id":58007193,"identity":"8d19525c-3580-4173-9b48-d45e197a92e5","added_by":"auto","created_at":"2024-06-09 17:59:47","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1330007,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1_covered_cd1868d3-86af-4d19-bddc-0cec8efd2102.pdf"},{"id":57035629,"identity":"2f5634e3-7943-4c1a-af84-aea8347a6ae8","added_by":"auto","created_at":"2024-05-23 18:34:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30527,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/10ae58873e25ad1b5fa7da7a.docx"},{"id":57035632,"identity":"d50a2cf1-78b9-4a66-ae44-a7b4cb39e278","added_by":"auto","created_at":"2024-05-23 18:34:05","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21834,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/b2043d32db8f0211a4e7dfdf.docx"},{"id":57035630,"identity":"b0afed41-c3d4-45bd-be50-16ae54887c80","added_by":"auto","created_at":"2024-05-23 18:34:05","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":21342,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/a8bcf98172bb380f528b3ffc.docx"},{"id":57035631,"identity":"02e4ee3c-59fc-4884-84c2-605e4dee0c85","added_by":"auto","created_at":"2024-05-23 18:34:05","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":23519,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-4397502/v1/8e046858fff13e8eb3481c58.docx"}],"financialInterests":"\u003cp\u003eNo competing interests reported.\u003c/p\u003e\n\u003cp\u003eTables 1-4 are available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"Development of a predictive nomogram for sepsis in patients with urolithiasis-related obstructive pyelonephritis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"uolithiasis-related obstructive pyelonephritis, sepsis, nomogram","lastPublishedDoi":"10.21203/rs.3.rs-4397502/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4397502/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: In patients with urolithiasis-related obstructive pyelonephritis (UROP), sepsis represents a critical and concerning complication that can substantially increase the mortality rate. This study aimed to identify the risk factors for sepsis in UROP patients and to develop a predictive nomogram model.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: We analyzed data from 148 patients who met the UROP criteria and were admitted to Chang Gung Memorial Hospital between January 1, 2016, and December 31, 2021. The primary outcome evaluated was the incidence of sepsis, as defined by the most recent Sepsis-3 guidelines. To identify potential risk factors for sepsis, we employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression technique. Subsequently, we utilized multivariable logistic regression to construct the predictive model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: There were a total of 102 non-sepsis cases and 46 sepsis cases. The sepsis group showed \u0026nbsp;significantly lower systolic blood pressure (p \u0026lt; 0.001), a higher heart rate (p = 0.002), a higher shock index (SI) (p \u0026lt; 0.001), a more prevalent history of diabetes mellitus (DM) (p = 0.015), and the mean hospital length of stay was significantly longer (p \u0026lt; 0.001). The laboratory results indicated a higher rate of positive blood culture in the sepsis group (60.9% vs 33.3%, p = 0.002), increased serum white blood cell counts (17.2 ± 10.9 103/uL vs 12.8 ± 6.4 103/uL, p = 0.014), a higher proportion of bandemia\u0026nbsp; (26.1% vs 4.1%, p \u0026lt; 0.001), elevated CRP levels (19.9 ± 9.8 mg/dL vs 9.9 ± 9.9 mg/dL, p \u0026lt; 0.001), and a higher neutrophil to lymphocyte ratio (NLR) (23.6 ± 20.3 vs 12.9 ± 10.1, p \u0026lt; 0.001). Risk factors for sepsis in multivariable analysis were a history of DM (OR = 4.24, p = 0.007), SI (x10-1) (OR = 1.55, p \u0026lt; 0.001), CRP (mg/dL) (OR = 1.08, p = 0.005), and NLR (x10) (OR = 1.58, p = 0.007).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: Our study demonstrated that patients with UROP who have DM, higher SI, higher NLR, and elevated CRP levels are significantly more likely to develop sepsis. These insights may aid in risk stratification, and it is imperative that clinicians promptly initiate treatment for those identified as high risk.\u003c/p\u003e","manuscriptTitle":"Development of a predictive nomogram for sepsis in patients with urolithiasis-related obstructive pyelonephritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-23 18:34:00","doi":"10.21203/rs.3.rs-4397502/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aeb5206e-c0bb-4c43-bf4f-248f5fb91397","owner":[],"postedDate":"May 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-09T17:51:35+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-23 18:34:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4397502","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4397502","identity":"rs-4397502","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}