Analysis of Risk Factors for SIRS after PCNL in Patients with Solitary Kidney

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Among the 51 patients evaluated, 12 (23.5%) developed SIRS. Multivariate analysis showed that a high urinary white blood cell count (p = 0.041; OR, 1.004; 95% CI, 1.000-1.008), prolonged operation time (p = 0.040; OR, 1.054; 95% CI, 1.005–1.107), and postoperative blood leukocyte count (p = 0.031; OR, 1.459; 95% CI, 1.020–2.061) were independent risk factors for SIRS after PCNL in patients with a solitary kidney. Given the unique physiological conditions of patients with solitary kidneys, who face a higher incidence of kidney stones and have lower risk tolerance, the results of this study provide insights into the risk factors for SIRS after PCNL in these patients. By identifying these factors, clinicians can better stratify risk, implement preventive and therapeutic measures in a timely manner, reduce the risk of SIRS, and improve overall patient outcomes. Solitary kidney renal calculi percutaneous nephrolithotomy (PCNL) leukocyte count Figures Figure 1 Introduction A solitary kidney refers to the absence or functional loss of one kidney due to congenital or acquired factors, with the remaining kidney being termed the solitary kidney. Among hospitalized urology patients, urinary tract stones are the most common condition, with an incidence rate of approximately 10–20% for kidney stones The incidence is continually increasing, and a high recurrence rate post-stone removal has been observed [ 1 ].Solitary kidney stones are a rare urological condition, categorized under complex urinary stones[ 2 ].These refer specifically to stones occurring in a kidney with unilateral functionality, potentially increasing the burden on the kidney and affecting its function. Solitary kidney stones often present as multiple and complex, making clinical treatment relatively challenging. These stones can cause urinary obstruction, leading to varying degrees of hydronephrosis over time and may be accompanied by electrolyte imbalance, acid-base disturbances, and renal function impairment[ 3 ]. Timely surgical intervention is crucial for patients with solitary kidneys and kidney stones to relieve obstruction and protect renal function while minimizing complications such as sepsis, septic shock, and renal insufficiency during the procedure. Percutaneous nephrolithotomy (PCNL) is one of the preferred methods for treating kidney stones due to its minimal invasiveness, high stone fragmentation, and clearance rates, making it particularly suitable for patients with complex stones. However, PCNL is also associated with complications like bleeding, infection, and injury.We observed that patients with solitary kidney stones are more prone to bleeding[ 4 ]and urinary tract infections [ 5 ].Systemic inflammatory response syndrome (SIRS) is a common complication after PCNL surgery, with a small proportion of patients potentially progressing to severe sepsis, which can be life-threatening[ 6 ].Reports indicate that 10–35% of patients develop SIRS after PCNL, with SIRS being considered the first step in the sepsis cascade, closely linked to the progression of sepsis[ 7 ].One of the primary reasons for the high mortality rate of urosepsis is delayed diagnosis, with septic shock having a critical time window during which timely and effective antibacterial treatment can improve prognosis [ 8 ].It is important to note that the occurrence of acute kidney injury significantly and independently negatively impacts the prognosis of patients with sepsis and septic shock[ 9 ]. However, for the unique and vulnerable population of solitary kidney patients, there is currently a lack of analysis on the risk factors for SIRS after PCNL in clinical practice. This study aims to explore the risk factors for SIRS in patients with solitary kidney stones post-PCNL to enable early prediction and timely intervention in the occurrence and evolution of SIRS. Materials and Methods This retrospective analysis received approval from the Ethics Committee of the First Affiliated Hospital of Gannan Medical University. Clinical data were gathered from patients diagnosed with solitary kidney stones and treated with PCNL surgery between January 2018 and January 2024.A solitary kidney is characterized by the absence or non-functionality of one kidney, stemming from congenital or acquired causes. The criteria for determining renal function loss included: less than 5% functionality in the contralateral kidney as demonstrated by 99mTc-DMSA single-photon emission computed tomography (SPECT), significant atrophy observed in the contralateral kidney through CT, or the absence of urine secretion in the contralateral kidney indicated by intravenous pyelography. After rigorous screening, 51 patients with solitary kidney stones who underwent PCNL treatment were included in this study. All patients underwent evaluation using abdominal X-ray and CT scans to determine the size and location of the solitary kidney stones. For patients with positive urine cultures, anti-infective treatments were administered based on drug sensitivity test results until urinalysis and body temperature normalized. For patients with negative urine cultures, prophylactic third-generation cephalosporins were administered intravenously 30 minutes before surgery. The surgical procedure adhered to the standardized prone PCNL protocol. Systemic inflammatory response syndrome (SIRS) was identified by the presence of two or more of the following criteria: (1) body temperature > 38°C or 90 bpm; (3) respiratory rate > 20 breaths/min or PaCO2 12×10^9 cells/L or < 4×10^9 cells/L. Data on the following parameters were collected and analyzed: demographic information such as age, gender, BMI, hypertension, diabetes, and history of ipsilateral PCNL surgery. Laboratory data included preoperative tests such as urine culture, urinary nitrite, urine white blood cell count, blood white blood cell count, neutrophil to lymphocyte ratio (NLR), serum creatinine, serum uric acid, serum potassium levels, and preoperative stenting; postoperative measurements included blood white blood cell count, serum creatinine, serum uric acid, serum potassium levels, maximum stone diameter (mm), surgical duration, and changes in hemoglobin, creatinine, and uric acid levels. Statistical analyses were performed using SPSS version 26.0. Categorical variables were expressed as frequencies and percentages and were compared using the chi-square test or Fisher's exact test. Continuous variables were initially tested for normality. Data conforming to a normal distribution were analyzed using the independent samples t-test, whereas data not conforming to a normal distribution were analyzed using the Mann–Whitney U test. Univariate and multivariate logistic regression analyses were employed to identify independent factors associated with SIRS following PCNL.A P-value of less than 0.05 was considered indicative of statistical significance. Receiver operating characteristic (ROC) curves were constructed to determine the cutoff values of variables by analyzing the area under the curve (AUC). Results We analyzed 51 patients with solitary kidney stones who underwent PCNL. Table 1 presents the demographic characteristics of the patients and the correlation between various factors and SIRS. The average age was54.75 ± 8.388 years, with 31 patients (60.7%) being male. Postoperative SIRS occurred in 12 patients (23.5%).Patients were divided into the SIRS group and the non-SIRS group based on the occurrence of SIRS post-surgery. Univariate analysis revealed six potential risk factors: preoperative urinary leukocyte count (p < 0.001), preoperative urine culture (p = 0.006), urinary nitrite (p = 0.001), the difference in white blood cell count before and after surgery (p = 0.000), operative duration (p = 0.009), and change in creatinine levels (p = 0.037).These variables were subsequently included in the multivariate logistic regression analysis. The results indicated that a high urinary leukocyte count (p = 0.041; OR, 1.004; 95% CI, 1.000-1.008), operative duration (p = 0.040; OR, 1.054; 95% CI, 1.005–1.107), and postoperative white blood cell count (p = 0.031; OR, 1.459; 95% CI, 1.020–2.061) were independent risk factors for SIRS following PCNL in patients with solitary kidney stones (Table 2 ).We further plotted ROC curves and used the AUC value to evaluate the predictive performance of systemic inflammatory response biomarkers (Table 3).The AUC value for preoperative urinary leukocyte count was 0.903, with a cutoff value based on ROC analysis maximizing the Youden index at 0.660.The optimal decision threshold for urinary leukocytes was > 270/µL, yielding a sensitivity of 91.7% and a specificity of 74.4%.The AUC value for postoperative leukocytes was 0.834, with the Youden index maximized at 0.705.The optimal decision threshold for immediate postoperative leukocytes was > 11.91, with a sensitivity of 83.3% and a specificity of 87.2%.The AUC value for operative duration was 0.747, with the Youden index maximized at 0.526.The optimal decision threshold for operative duration was > 122 minutes, with a sensitivity of 83.3% and a specificity of 69.2%. Table 1 Baseline characteristics and perioperative outcomes of included patients Variables Non SIRS (n = 39) SIRS (n = 12) p value Patient characteristics Age (years);mean ± SD 54.92 ± 8.39 54.17 ± 8.72 0.788 Sex (male/female); N (%) 0.889 Male 23(59.0%) 8(66.7%) Female 16(41.0%) 4(33.3%) BMI (kg/m 2 ); mean ± SD 21.86 ± 2.70 21.30 ± 3.01 0.542 Diabetes; N (%) 0.960 Yes 11(2.5%) 1(8.3%) No 28(97.5%) 11(91.7%) Hypertension; N (%) 0.379 Yes 11(28.2%) 5(41.7%) No 28(71.8%) 7(58.3%) Previous ipsilateral surgery; N (%) 0.303 Yes 11(28.2%) 1(8.3%) No 28(71.8%) 11(91.7%) Preoperative data urinary nitrite; N (%) 0.001* Positive 2(5.1%) 6(50.0%) Negative 37(94.9%) 6(50.0%) Urine culture; N (%) 0.006* Positive 7(17.9%) 7(58.3%) Negative 32(82.1%) 5(41.7%) longest stone diameter (mm); mean ± SD 21.03 ± 7.62 24.33 ± 5.31 0.169 nephrostomy; N (%) 5(12.8%) 1(8.3%) 1.000 Double J stent; N (%) 9(23.1%) 4(33.3%) 0.738 Urine leukocyte (10 9 /L); median (IQR) 130.50 (3.9-1651.7) 1102.60 (196.3-10485.0) < 0.001* leukocyte count (10 9 /L); mean ± SD 7.01 ± 2.77 7.82 ± 1.94 0.352 NLR; median (IQR) 2.64 (1.20-22.53) 2.73 (1.32–7.67) 0.903 Serum Creatinine (µmol/L); mean ± SD 129.41 ± 42.36 147.50 ± 85.66 0.493 uric acid (µmol/L); mean ± SD 404.69 ± 120.87 395.08 ± 117.22 0.809 potassium ions (mmol/L); mean ± SD 4.03 ± 0.46 3.92 ± 0.49 0.475 postoperative data Operative time (min); mean ± SD 106.92 ± 32.13 136.17 ± 34.73 0.009* leukocyte count (10 9 /L); mean ± SD 8.93 ± 3.68 14.41 ± 4.05 < 0.001* Serum Creatinine (µmol/L); mean ± SD 122.95 ± 35.39 157.75 ± 80.94 0.173 uric acid (µmol/L); mean ± SD 343.36 ± 101.62 310.58 ± 85.35 0.317 potassium ions (mmol/L); mean ± SD 4.06 ± 0.51 3.97 ± 0.54 0.584 creatinine change (µmol/L); mean ± SD -6.46 ± 23.49 10.25 ± 23.94 0.037* Uric acid change (µmol/L); mean ± SD 61.33 ± 87.4 84.50 ± 74.62 0.411 Hemoglobin change (g/L); mean ± SD -5.41 ± 11.40 -9.33 ± 13.78 0.326 *Values are statistically significant Table 2 Univariate and multivariate analyses for predicting SIRS after PCNL Variables Univariate analysis Multivariate analysis OR (95% CI) p value OR (95% CI) P value urinary nitrite 18.5(3.00–113.95) 0.002 urine culture 6.4(1.56–26.19) 0.01 Urine leukocyte 1.003(1.001–1.005) 0.01 1.004(1.000-1.008) 0.041 Operative time 1.027(1.005–1.050) 0.018 1.054(1.005–1.107) 0.031 leukocyte count 1.43(1.150–1.790) 0.001 1.459(1.017–2.095) 0.040 creatinine change 1.037(1.000-1.074) 0.047 Discussion Percutaneous nephrolithotomy (PCNL), known for its minimally invasive nature, effective stone fragmentation, and rapid recovery of patients, has been widely adopted in the clinical treatment of kidney stones, especially in cases of large, multiple, or complex kidney stones[ 10 ].Despite these advantages, postoperative infection remains a significant concern, as one of the primary causes of early mortality following PCNL[ 11 ].If not promptly controlled, such infections can progress to sepsis. Reports indicate that the incidence of septic shock after PCNL ranges from 0.3–9.3%, which is 20 times higher than the incidence in other types of endourological procedures [ 12 , 13 ].Additionally, sepsis and the systemic inflammatory response syndrome (SIRS) are major causes of acute renal failure (ARF) [ 14 ].In patients with solitary kidney stones, the risk of renal insufficiency is particularly pronounced. It has been reported that the risk of death sharply increases once acute kidney injury (AKI) occurs [ 15 ].However, to our knowledge, there are no specific evaluations for patients with solitary kidneys who have lower resistance to risk, and the risk factors for developing SIRS after PCNL in these patients remain unexamined. Therefore, research on SIRS is particularly urgent to facilitate early diagnosis and timely treatment, reduce incidence rates, and accelerate postoperative recovery. Urinalysis, due to its cost-effectiveness and rapid procedures, is widely used by urologists for clinical diagnosis, playing a crucial role in the early detection of urinary tract infections (UTIs).Currently, UTIs are among the most common bacterial infections [ 16 ].Preoperative combined detection of urinary nitrite and leukocytes in the urine has been shown to have high accuracy in diagnosing UTIs[ 17 ].In recent years, risk factors for infection following percutaneous nephrolithotomy (PCNL) have garnered significant attention, with positive leukocytes in urine confirmed to significantly increase the risk of postoperative infection. Reports indicate that patients with urine leukocyte ≥ 25/µL have a fourfold increase in risk of septic shock compared to those with leukocyte < 25/µL[ 18 ].Chen et al.'s study further indicated that patients with urine leukocyte ≥ 10/HP have an approximately 14.9-fold increase in risk of urosepsis[ 19 ].Patients with isolated kidneys often present with severe clinical conditions once stones cause obstruction or infection. Among the 51 cases of isolated kidney stones we collected, a high proportion had positive preoperative urine leukocytes, likely due to their specific conditions. Therefore, using urine leukocyte count as a risk factor for analysis may be more appropriate for this special population. Our study is the first to confirm that preoperative urine leukocyte counts were significantly higher in the SIRS group compared to the non-SIRS group among isolated kidney stone patients. Multivariate analysis established it as an independent risk factor. Studies have reported that the clinical symptoms and signs of isolated kidney stones are similar to those of general kidney stone patients, but stones are more likely to cause UTIs in isolated kidney patients [ 5 ].UTIs have been identified as an independent predictor of renal function deterioration, particularly when vesicoureteral reflux and indwelling ureteral stents are present. These conditions increase the risk of bacterial colonization and renal parenchyma damage[ 20 ].Indwelling stents increase the risk of UTIs by 49%, and the duration of stent placement is associated with an increased risk of UTIs [ 21 ].Additionally, some patients develop stones on the outer surface of the stent, making removal difficult and sometimes leading to stent avulsion. This is a particular concern for isolated kidney patients [ 22 ].Therefore, in our special population, infection should be strictly controlled based on the preoperative urine leukocyte count. This includes appropriate extension of antibiotic use and timely removal or replacement of ureteral stents to prevent the occurrence of SIRS and aid postoperative recovery. Research has demonstrated that prolonged surgical duration is associated with an increased incidence of post-operative SIRS in general kidney stone patients[ 23 ] .It has become a consensus among many researchers that surgical duration is a risk factor for SIRS.[ 23 , 24 ].Our study similarly found that, in patients with a solitary kidney, surgical duration is an independent predictor. This extension is often related to multiple factors such as high stone burden, high stone density, concealed stone locations, severe infection status, or intraoperative bleeding. Studies have demonstrated that a higher stone burden directly increases the difficulty of the surgery, leading to greater friction with the urinary tract mucosa, and is also more likely to contain pathogens and endotoxins [ 25 ].Considering the characteristics of solitary kidneys, which include renal cortex thickening, high blood flow, and high perfusion, solitary kidneys are significant factors in bleeding post-PCNL[ 4 , 26 ].In clinical practice, intraoperative bleeding can obscure the surgical field, increasing the difficulty of the procedure and raising the risk and duration of the surgery. To improve the surgical view, surgeons may need to increase irrigation pressure to expand the renal pelvis and remove stone fragments. Prolonged irrigation may result in elevated intrarenal pressure, potentially leading to venous rupture, which provides a pathway for bacteria or toxins to enter the bloodstream, thus increasing the risk of infection and sepsis[ 27 ].Additionally, extended surgical duration may increase the reflux of urine and irrigation fluids, along with the associated absorption of bacteria and toxins, thereby heightening the likelihood of post-operative systemic inflammatory response syndrome (SIRS)[ 28 ].Moreover, longer surgical duration implies extended exposure time, and repeated contact between the puncture site and surgical instruments increases the risk of infection and renal function impairment. Notably, our study identified surgical duration as a strong predictive indicator in solitary kidney patients, with a threshold of 122 minutes. This threshold is close to the critical surgical time reported in the literature for the occurrence of uremia after percutaneous nephrolithotomy in general stone patients[ 29 ]. Leukocytes, which function as immune cells in the blood, are common indicators of the body's response to infection or inflammation and are commonly utilized as clinical biomarkers for acute infections. In the postoperative setting, an increase in leukocytes may indicate an infection, but it might also be part of a normal surgical response[ 30 ].In other words, the elevation of leukocytes after PCNL may be a physiological adaptation to surgery, but it might also be closely related to the development of SIRS or even sepsis. This study undertook an in-depth analysis of the correlation between preoperative and postoperative white blood cell levels and the occurrence of SIRS. Previous studies have reported that for general kidney stone patients, a high preoperative white blood cell count is an independent risk factor for the occurrence of SIRS after PCNL[ 31 ].However, our findings indicate that in the solitary kidney population, preoperative white blood cell counts were generally within the normal range, and no significant association was observed between these counts and the occurrence of postoperative SIRS. This may be due to the poor risk tolerance of solitary kidney patients, for whom preoperative antibiotic treatment or other preventive measures may have mitigated inflammation and the white blood cell response. Conversely, we found that an elevated postoperative white blood cell count was an independent risk factor for the occurrence of SIRS after PCNL for solitary kidney stones. The average white blood cell count in the SIRS group (14.41 ± 4.05×10^9/L) was significantly higher than that in the non-SIRS group. According to Bozkurt et al., a postoperative white blood cell count exceeding 14.05×10^9/L is closely related to the occurrence of sepsis [ 32 ].Preoperative control of leukocytes within the normal range is crucial; however, the source of infection during surgery may lead to the entry of pathogens and endotoxins into the blood, resulting in a reactive increase in postoperative leukocytes and further complicating the occurrence of systemic inflammatory response syndrome. Limitations of Our Study: Firstly, due to the rarity of solitary kidney stone patients with this specific type of urolithiasis in clinical practice, our study is a retrospective analysis with a small sample size. Secondly, the clinical data were obtained from a single-center institution, which may result in potential selection bias. Given these limitations, more extensive prospective multicenter studies are needed in the future to further validate our findings. Conclusion Our study identified that elevated urinary white blood cell count, prolonged operative time, and increased postoperative blood white cell count are independent predictors for the occurrence of systemic inflammatory response syndrome (SIRS) in solitary kidney stone patients following percutaneous nephrolithotomy (PCNL).Notably, these predictors are not only common but also easily obtainable through routine clinical testing, spanning the entire treatment process, from preoperative evaluation and intraoperative monitoring to postoperative management. Declarations Conflict of interest The authors declare no financial interests are relevant to this work. Ethical approval This study was approved by the Institutional Ethics Committee (IEC) of the First Affiliated Hospital of Gannan Medical University. Funding The Doctoral Research Start-up Fund from the First Affiliated Hospital of Gannan Medical University (QD073). The Technology Plan Project from the Health Commission of Jiangxi Province (202310800). The Technology Research Project from the Health Commission of Ganzhou City (2023-2-088) Author Contribution Author Contribution Statement:In this study, the specific contributions of each author are as follows:Y. Fang: Led the study design, was responsible for data collection, and the primary drafting of the manuscript.Y. Liu : Participated in the study design, and was in charge of statistical analysis and interpretation of the data.H. Huang : Engaged in data collection and the organization of clinical information.J. Gui : Handled literature searches and authored parts of the theoretical discussion.X. Wang : Assisted in statistical analysis and validated the results.G. Zhang : Participated in the study design and contributed to the interpretation of data and the writing of the discussion section.X. Zou : Responsible for the creation of figures and tables, as well as the visualization of data.T. Xie : Managed the final review and submission of the manuscript.All authors participated in the discussion of the study results, reviewed the manuscript, and agreed on the final version of the manuscript. Data Availability The data is provided in the manuscript or supplementary information file. References Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T (2016) EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol 69:468–474 Peerapen P, Thongboonkerd V (2023) Kidney Stone Prev Adv Nutr 14:555–569 Huang Z, Fu F, Zhong Z, Zhang L, Xu R, Zhao X (2012) Chinese minimally invasive percutaneous nephrolithotomy for intrarenal stones in patients with solitary kidney: a single-center experience. PLoS ONE 7:e40577 El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA (2007) Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. 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Supplementary Files 2x2ContingencyTable.xlsx Age.sav Diabetes.sav DoubleJstent.sav Hypertension.sav NormalityTestAnalysis.spv Positiveurineculture.sav Preoperativenephrostomy.sav Preoperativeurinarynitrite.sav Previousipsilateralsurgery.sav ROCCurve.spv SPSSAlldata.sav TheMannWhitneyUtest.spv Theindependentsamplesttest.spv Themeanandmedianofthedata.spv rawclinicaldata.xlsx Cite Share Download PDF Status: Published Journal Publication published 21 Dec, 2024 Read the published version in Urolithiasis → Version 1 posted Editorial decision: Revision requested 27 Sep, 2024 Reviews received at journal 05 Aug, 2024 Reviewers agreed at journal 28 Jul, 2024 Reviewers agreed at journal 27 Jul, 2024 Reviewers invited by journal 26 Jul, 2024 Editor assigned by journal 25 Jul, 2024 Submission checks completed at journal 25 Jul, 2024 First submitted to journal 24 Jul, 2024 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. 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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-4795877","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":336334315,"identity":"db44fe30-e815-4ae8-99b6-58aeef0d5f6a","order_by":0,"name":"YuJu Fang","email":"","orcid":"","institution":"Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"YuJu","middleName":"","lastName":"Fang","suffix":""},{"id":336334316,"identity":"5001b177-a3be-498a-ae0f-40fb2fbfa933","order_by":1,"name":"Yaqin Liu","email":"","orcid":"","institution":"Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yaqin","middleName":"","lastName":"Liu","suffix":""},{"id":336334318,"identity":"ff90a383-c03e-4152-b2ec-609b8c3903ab","order_by":2,"name":"Haibing Huang","email":"","orcid":"","institution":"Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haibing","middleName":"","lastName":"Huang","suffix":""},{"id":336334320,"identity":"a64a579f-e93c-455e-a33e-81d7dbe9dd4f","order_by":3,"name":"Jiaqiang Gui","email":"","orcid":"","institution":"Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiaqiang","middleName":"","lastName":"Gui","suffix":""},{"id":336334322,"identity":"df234d95-b95f-45b5-bb47-bf102bc70a2c","order_by":4,"name":"Xiaoning Wang","email":"","orcid":"","institution":"Department of Urology, The First Affiliated Hospital of Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoning","middleName":"","lastName":"Wang","suffix":""},{"id":336334324,"identity":"00d02fc1-da92-41a0-bc08-4e2502530d34","order_by":5,"name":"Guoxi Zhang","email":"","orcid":"","institution":"Department of Urology, The First Affiliated Hospital of Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Guoxi","middleName":"","lastName":"Zhang","suffix":""},{"id":336334327,"identity":"331640a9-8de9-4e7b-b788-f88720c40b5d","order_by":6,"name":"Xiaofeng Zou","email":"","orcid":"","institution":"Department of Urology, The First Affiliated Hospital of Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaofeng","middleName":"","lastName":"Zou","suffix":""},{"id":336334329,"identity":"61e2ecf3-c197-4efc-b9f2-ef31118c0c55","order_by":7,"name":"Tian peng Xie","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIie2PMWuDQBiG7zg4F8X1EyH5C4pLfs7dlEUkxSVDKB8IydbZIfQ3dMpa4UAXoRkdOpgEMidLaZcQQdtRHQu5Bz54h/fh5SNEo/mPsOZEG42fyxIm0xEKxU4hLpSzwMfhHfrXAWu9lCQb6HsFK+p69RnZ7mbvOa8gKLLDsepRnIRLFPk5drblQjztIDIID4KwR7GZ6aPgSr5VocicHcQUTe72KZzZVxQ3Jd+rUKK1BYnZgNKsUJTrZgXmilg4Qml+8VP5omKoQs4gh8BPBn7xPlR9/f5SkZ3Oz/Syep5MjeRw6lN+EYSYXhvZiHqnGPXIrkaj0Twad4xKTWgsVBIGAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Urology, The First Affiliated Hospital of Gannan Medical University","correspondingAuthor":true,"prefix":"","firstName":"Tian","middleName":"peng","lastName":"Xie","suffix":""}],"badges":[],"createdAt":"2024-07-24 13:48:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4795877/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4795877/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00240-024-01681-1","type":"published","date":"2024-12-21T15:57:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63371821,"identity":"6825dd80-5b98-4361-98a3-7dff26ebf9ee","added_by":"auto","created_at":"2024-08-27 12:01:00","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":69760,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic (ROC) curve analysis results of Urine leukocyte, Operative time and leukocyte count in predicting postoperative SIRS\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4795877/v1/7542fd7754ef9f895b81c29f.jpg"},{"id":72202739,"identity":"96013970-ebff-4acc-9c4b-29c8e20b3fc8","added_by":"auto","created_at":"2024-12-23 16:15:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":576656,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4795877/v1/4eaf5773-763a-43c3-b99a-b56dda903950.pdf"},{"id":63369579,"identity":"d35977ab-701e-4ef1-bc46-45aebf525a53","added_by":"auto","created_at":"2024-08-27 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12:09:00","extension":"spv","order_by":19,"title":"","display":"","copyAsset":false,"role":"supplement","size":9919,"visible":true,"origin":"","legend":"","description":"","filename":"Themeanandmedianofthedata.spv","url":"https://assets-eu.researchsquare.com/files/rs-4795877/v1/d28d2cca41120403645eefc6.spv"},{"id":63369588,"identity":"0d91d3f6-07de-4086-bc22-a422f3e8c55d","added_by":"auto","created_at":"2024-08-27 11:45:00","extension":"xlsx","order_by":20,"title":"","display":"","copyAsset":false,"role":"supplement","size":19094,"visible":true,"origin":"","legend":"","description":"","filename":"rawclinicaldata.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4795877/v1/cc0f0b34b1557d845864ec03.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of Risk Factors for SIRS after PCNL in Patients with Solitary Kidney","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA solitary kidney refers to the absence or functional loss of one kidney due to congenital or acquired factors, with the remaining kidney being termed the solitary kidney. Among hospitalized urology patients, urinary tract stones are the most common condition, with an incidence rate of approximately 10\u0026ndash;20% for kidney stones The incidence is continually increasing, and a high recurrence rate post-stone removal has been observed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].Solitary kidney stones are a rare urological condition, categorized under complex urinary stones[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].These refer specifically to stones occurring in a kidney with unilateral functionality, potentially increasing the burden on the kidney and affecting its function. Solitary kidney stones often present as multiple and complex, making clinical treatment relatively challenging. These stones can cause urinary obstruction, leading to varying degrees of hydronephrosis over time and may be accompanied by electrolyte imbalance, acid-base disturbances, and renal function impairment[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTimely surgical intervention is crucial for patients with solitary kidneys and kidney stones to relieve obstruction and protect renal function while minimizing complications such as sepsis, septic shock, and renal insufficiency during the procedure. Percutaneous nephrolithotomy (PCNL) is one of the preferred methods for treating kidney stones due to its minimal invasiveness, high stone fragmentation, and clearance rates, making it particularly suitable for patients with complex stones. However, PCNL is also associated with complications like bleeding, infection, and injury.We observed that patients with solitary kidney stones are more prone to bleeding[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]and urinary tract infections [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].Systemic inflammatory response syndrome (SIRS) is a common complication after PCNL surgery, with a small proportion of patients potentially progressing to severe sepsis, which can be life-threatening[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].Reports indicate that 10\u0026ndash;35% of patients develop SIRS after PCNL, with SIRS being considered the first step in the sepsis cascade, closely linked to the progression of sepsis[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].One of the primary reasons for the high mortality rate of urosepsis is delayed diagnosis, with septic shock having a critical time window during which timely and effective antibacterial treatment can improve prognosis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].It is important to note that the occurrence of acute kidney injury significantly and independently negatively impacts the prognosis of patients with sepsis and septic shock[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, for the unique and vulnerable population of solitary kidney patients, there is currently a lack of analysis on the risk factors for SIRS after PCNL in clinical practice. This study aims to explore the risk factors for SIRS in patients with solitary kidney stones post-PCNL to enable early prediction and timely intervention in the occurrence and evolution of SIRS.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This retrospective analysis received approval from the Ethics Committee of the First Affiliated Hospital of Gannan Medical University. Clinical data were gathered from patients diagnosed with solitary kidney stones and treated with PCNL surgery between January 2018 and January 2024.A solitary kidney is characterized by the absence or non-functionality of one kidney, stemming from congenital or acquired causes. The criteria for determining renal function loss included: less than 5% functionality in the contralateral kidney as demonstrated by 99mTc-DMSA single-photon emission computed tomography (SPECT), significant atrophy observed in the contralateral kidney through CT, or the absence of urine secretion in the contralateral kidney indicated by intravenous pyelography. After rigorous screening, 51 patients with solitary kidney stones who underwent PCNL treatment were included in this study. All patients underwent evaluation using abdominal X-ray and CT scans to determine the size and location of the solitary kidney stones. For patients with positive urine cultures, anti-infective treatments were administered based on drug sensitivity test results until urinalysis and body temperature normalized. For patients with negative urine cultures, prophylactic third-generation cephalosporins were administered intravenously 30 minutes before surgery. The surgical procedure adhered to the standardized prone PCNL protocol. Systemic inflammatory response syndrome (SIRS) was identified by the presence of two or more of the following criteria: (1) body temperature\u0026thinsp;\u0026gt;\u0026thinsp;38\u0026deg;C or \u0026lt;\u0026thinsp;36\u0026deg;C; (2) heart rate\u0026thinsp;\u0026gt;\u0026thinsp;90 bpm; (3) respiratory rate\u0026thinsp;\u0026gt;\u0026thinsp;20 breaths/min or PaCO2\u0026thinsp;\u0026lt;\u0026thinsp;32 mmHg; (4) white blood cell count\u0026thinsp;\u0026gt;\u0026thinsp;12\u0026times;10^9 cells/L or \u0026lt;\u0026thinsp;4\u0026times;10^9 cells/L.\u003c/p\u003e \u003cp\u003eData on the following parameters were collected and analyzed: demographic information such as age, gender, BMI, hypertension, diabetes, and history of ipsilateral PCNL surgery. Laboratory data included preoperative tests such as urine culture, urinary nitrite, urine white blood cell count, blood white blood cell count, neutrophil to lymphocyte ratio (NLR), serum creatinine, serum uric acid, serum potassium levels, and preoperative stenting; postoperative measurements included blood white blood cell count, serum creatinine, serum uric acid, serum potassium levels, maximum stone diameter (mm), surgical duration, and changes in hemoglobin, creatinine, and uric acid levels.\u003c/p\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 26.0. Categorical variables were expressed as frequencies and percentages and were compared using the chi-square test or Fisher's exact test. Continuous variables were initially tested for normality. Data conforming to a normal distribution were analyzed using the independent samples t-test, whereas data not conforming to a normal distribution were analyzed using the Mann\u0026ndash;Whitney U test. Univariate and multivariate logistic regression analyses were employed to identify independent factors associated with SIRS following PCNL.A P-value of less than 0.05 was considered indicative of statistical significance. Receiver operating characteristic (ROC) curves were constructed to determine the cutoff values of variables by analyzing the area under the curve (AUC).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe analyzed 51 patients with solitary kidney stones who underwent PCNL. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic characteristics of the patients and the correlation between various factors and SIRS. The average age was54.75\u0026thinsp;\u0026plusmn;\u0026thinsp;8.388 years, with 31 patients (60.7%) being male. Postoperative SIRS occurred in 12 patients (23.5%).Patients were divided into the SIRS group and the non-SIRS group based on the occurrence of SIRS post-surgery. Univariate analysis revealed six potential risk factors: preoperative urinary leukocyte count (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), preoperative urine culture (p\u0026thinsp;=\u0026thinsp;0.006), urinary nitrite (p\u0026thinsp;=\u0026thinsp;0.001), the difference in white blood cell count before and after surgery (p\u0026thinsp;=\u0026thinsp;0.000), operative duration (p\u0026thinsp;=\u0026thinsp;0.009), and change in creatinine levels (p\u0026thinsp;=\u0026thinsp;0.037).These variables were subsequently included in the multivariate logistic regression analysis. The results indicated that a high urinary leukocyte count (p\u0026thinsp;=\u0026thinsp;0.041; OR, 1.004; 95% CI, 1.000-1.008), operative duration (p\u0026thinsp;=\u0026thinsp;0.040; OR, 1.054; 95% CI, 1.005\u0026ndash;1.107), and postoperative white blood cell count (p\u0026thinsp;=\u0026thinsp;0.031; OR, 1.459; 95% CI, 1.020\u0026ndash;2.061) were independent risk factors for SIRS following PCNL in patients with solitary kidney stones (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).We further plotted ROC curves and used the AUC value to evaluate the predictive performance of systemic inflammatory response biomarkers (Table\u0026nbsp;3).The AUC value for preoperative urinary leukocyte count was 0.903, with a cutoff value based on ROC analysis maximizing the Youden index at 0.660.The optimal decision threshold for urinary leukocytes was \u0026gt;\u0026thinsp;270/\u0026micro;L, yielding a sensitivity of 91.7% and a specificity of 74.4%.The AUC value for postoperative leukocytes was 0.834, with the Youden index maximized at 0.705.The optimal decision threshold for immediate postoperative leukocytes was \u0026gt;\u0026thinsp;11.91, with a sensitivity of 83.3% and a specificity of 87.2%.The AUC value for operative duration was 0.747, with the Youden index maximized at 0.526.The optimal decision threshold for operative duration was \u0026gt;\u0026thinsp;122 minutes, with a sensitivity of 83.3% and a specificity of 69.2%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eBaseline characteristics and perioperative outcomes of included patients\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon SIRS (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSIRS (n\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years);mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.92\u0026thinsp;\u0026plusmn;\u0026thinsp;8.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male/female); \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(41.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes; \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(97.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension; \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.379\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(28.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(71.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(58.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious ipsilateral surgery; \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(28.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(71.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative data\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eurinary nitrite; \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(94.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine culture; \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(17.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(58.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(82.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elongest stone diameter (mm); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.03\u0026thinsp;\u0026plusmn;\u0026thinsp;7.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enephrostomy; \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(12.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDouble J stent; \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine leukocyte (10\u003csup\u003e9\u003c/sup\u003e/L); median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130.50 (3.9-1651.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1102.60\u003c/p\u003e \u003cp\u003e(196.3-10485.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eleukocyte count (10\u003csup\u003e9\u003c/sup\u003e/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR; median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.64 (1.20-22.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.73 (1.32\u0026ndash;7.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Creatinine (\u0026micro;mol/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129.41\u0026thinsp;\u0026plusmn;\u0026thinsp;42.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147.50\u0026thinsp;\u0026plusmn;\u0026thinsp;85.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.493\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003euric acid (\u0026micro;mol/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e404.69\u0026thinsp;\u0026plusmn;\u0026thinsp;120.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e395.08\u0026thinsp;\u0026plusmn;\u0026thinsp;117.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epotassium ions (mmol/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003epostoperative data\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time (min); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106.92\u0026thinsp;\u0026plusmn;\u0026thinsp;32.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136.17\u0026thinsp;\u0026plusmn;\u0026thinsp;34.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eleukocyte count (10\u003csup\u003e9\u003c/sup\u003e/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.41\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum Creatinine (\u0026micro;mol/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122.95\u0026thinsp;\u0026plusmn;\u0026thinsp;35.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157.75\u0026thinsp;\u0026plusmn;\u0026thinsp;80.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003euric acid (\u0026micro;mol/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e343.36\u0026thinsp;\u0026plusmn;\u0026thinsp;101.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e310.58\u0026thinsp;\u0026plusmn;\u0026thinsp;85.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epotassium ions (mmol/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecreatinine change (\u0026micro;mol/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-6.46\u0026thinsp;\u0026plusmn;\u0026thinsp;23.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.25\u0026thinsp;\u0026plusmn;\u0026thinsp;23.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.037*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUric acid change (\u0026micro;mol/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.33\u0026thinsp;\u0026plusmn;\u0026thinsp;87.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.50\u0026thinsp;\u0026plusmn;\u0026thinsp;74.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin change (g/L); mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.41\u0026thinsp;\u0026plusmn;\u0026thinsp;11.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-9.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Values are statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eUnivariate and multivariate analyses for predicting SIRS after PCNL\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eurinary nitrite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18.5(3.00\u0026ndash;113.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eurine culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.4(1.56\u0026ndash;26.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine leukocyte\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.003(1.001\u0026ndash;1.005)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.004(1.000-1.008)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.027(1.005\u0026ndash;1.050)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.054(1.005\u0026ndash;1.107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eleukocyte count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.43(1.150\u0026ndash;1.790)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.459(1.017\u0026ndash;2.095)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecreatinine change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.037(1.000-1.074)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003ePercutaneous nephrolithotomy (PCNL), known for its minimally invasive nature, effective stone fragmentation, and rapid recovery of patients, has been widely adopted in the clinical treatment of kidney stones, especially in cases of large, multiple, or complex kidney stones[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].Despite these advantages, postoperative infection remains a significant concern, as one of the primary causes of early mortality following PCNL[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].If not promptly controlled, such infections can progress to sepsis. Reports indicate that the incidence of septic shock after PCNL ranges from 0.3\u0026ndash;9.3%, which is 20 times higher than the incidence in other types of endourological procedures [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].Additionally, sepsis and the systemic inflammatory response syndrome (SIRS) are major causes of acute renal failure (ARF) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].In patients with solitary kidney stones, the risk of renal insufficiency is particularly pronounced. It has been reported that the risk of death sharply increases once acute kidney injury (AKI) occurs [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].However, to our knowledge, there are no specific evaluations for patients with solitary kidneys who have lower resistance to risk, and the risk factors for developing SIRS after PCNL in these patients remain unexamined. Therefore, research on SIRS is particularly urgent to facilitate early diagnosis and timely treatment, reduce incidence rates, and accelerate postoperative recovery.\u003c/p\u003e \u003cp\u003eUrinalysis, due to its cost-effectiveness and rapid procedures, is widely used by urologists for clinical diagnosis, playing a crucial role in the early detection of urinary tract infections (UTIs).Currently, UTIs are among the most common bacterial infections [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].Preoperative combined detection of urinary nitrite and leukocytes in the urine has been shown to have high accuracy in diagnosing UTIs[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].In recent years, risk factors for infection following percutaneous nephrolithotomy (PCNL) have garnered significant attention, with positive leukocytes in urine confirmed to significantly increase the risk of postoperative infection. Reports indicate that patients with urine leukocyte\u0026thinsp;\u0026ge;\u0026thinsp;25/\u0026micro;L have a fourfold increase in risk of septic shock compared to those with leukocyte\u0026thinsp;\u0026lt;\u0026thinsp;25/\u0026micro;L[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].Chen et al.'s study further indicated that patients with urine leukocyte\u0026thinsp;\u0026ge;\u0026thinsp;10/HP have an approximately 14.9-fold increase in risk of urosepsis[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].Patients with isolated kidneys often present with severe clinical conditions once stones cause obstruction or infection. Among the 51 cases of isolated kidney stones we collected, a high proportion had positive preoperative urine leukocytes, likely due to their specific conditions. Therefore, using urine leukocyte count as a risk factor for analysis may be more appropriate for this special population. Our study is the first to confirm that preoperative urine leukocyte counts were significantly higher in the SIRS group compared to the non-SIRS group among isolated kidney stone patients. Multivariate analysis established it as an independent risk factor. Studies have reported that the clinical symptoms and signs of isolated kidney stones are similar to those of general kidney stone patients, but stones are more likely to cause UTIs in isolated kidney patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].UTIs have been identified as an independent predictor of renal function deterioration, particularly when vesicoureteral reflux and indwelling ureteral stents are present. These conditions increase the risk of bacterial colonization and renal parenchyma damage[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].Indwelling stents increase the risk of UTIs by 49%, and the duration of stent placement is associated with an increased risk of UTIs [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].Additionally, some patients develop stones on the outer surface of the stent, making removal difficult and sometimes leading to stent avulsion. This is a particular concern for isolated kidney patients [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].Therefore, in our special population, infection should be strictly controlled based on the preoperative urine leukocyte count. This includes appropriate extension of antibiotic use and timely removal or replacement of ureteral stents to prevent the occurrence of SIRS and aid postoperative recovery.\u003c/p\u003e \u003cp\u003eResearch has demonstrated that prolonged surgical duration is associated with an increased incidence of post-operative SIRS in general kidney stone patients[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] .It has become a consensus among many researchers that surgical duration is a risk factor for SIRS.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].Our study similarly found that, in patients with a solitary kidney, surgical duration is an independent predictor. This extension is often related to multiple factors such as high stone burden, high stone density, concealed stone locations, severe infection status, or intraoperative bleeding. Studies have demonstrated that a higher stone burden directly increases the difficulty of the surgery, leading to greater friction with the urinary tract mucosa, and is also more likely to contain pathogens and endotoxins [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].Considering the characteristics of solitary kidneys, which include renal cortex thickening, high blood flow, and high perfusion, solitary kidneys are significant factors in bleeding post-PCNL[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].In clinical practice, intraoperative bleeding can obscure the surgical field, increasing the difficulty of the procedure and raising the risk and duration of the surgery. To improve the surgical view, surgeons may need to increase irrigation pressure to expand the renal pelvis and remove stone fragments. Prolonged irrigation may result in elevated intrarenal pressure, potentially leading to venous rupture, which provides a pathway for bacteria or toxins to enter the bloodstream, thus increasing the risk of infection and sepsis[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].Additionally, extended surgical duration may increase the reflux of urine and irrigation fluids, along with the associated absorption of bacteria and toxins, thereby heightening the likelihood of post-operative systemic inflammatory response syndrome (SIRS)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].Moreover, longer surgical duration implies extended exposure time, and repeated contact between the puncture site and surgical instruments increases the risk of infection and renal function impairment. Notably, our study identified surgical duration as a strong predictive indicator in solitary kidney patients, with a threshold of 122 minutes. This threshold is close to the critical surgical time reported in the literature for the occurrence of uremia after percutaneous nephrolithotomy in general stone patients[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLeukocytes, which function as immune cells in the blood, are common indicators of the body's response to infection or inflammation and are commonly utilized as clinical biomarkers for acute infections. In the postoperative setting, an increase in leukocytes may indicate an infection, but it might also be part of a normal surgical response[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].In other words, the elevation of leukocytes after PCNL may be a physiological adaptation to surgery, but it might also be closely related to the development of SIRS or even sepsis. This study undertook an in-depth analysis of the correlation between preoperative and postoperative white blood cell levels and the occurrence of SIRS. Previous studies have reported that for general kidney stone patients, a high preoperative white blood cell count is an independent risk factor for the occurrence of SIRS after PCNL[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].However, our findings indicate that in the solitary kidney population, preoperative white blood cell counts were generally within the normal range, and no significant association was observed between these counts and the occurrence of postoperative SIRS. This may be due to the poor risk tolerance of solitary kidney patients, for whom preoperative antibiotic treatment or other preventive measures may have mitigated inflammation and the white blood cell response. Conversely, we found that an elevated postoperative white blood cell count was an independent risk factor for the occurrence of SIRS after PCNL for solitary kidney stones. The average white blood cell count in the SIRS group (14.41\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u0026times;10^9/L) was significantly higher than that in the non-SIRS group. According to Bozkurt et al., a postoperative white blood cell count exceeding 14.05\u0026times;10^9/L is closely related to the occurrence of sepsis [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].Preoperative control of leukocytes within the normal range is crucial; however, the source of infection during surgery may lead to the entry of pathogens and endotoxins into the blood, resulting in a reactive increase in postoperative leukocytes and further complicating the occurrence of systemic inflammatory response syndrome.\u003c/p\u003e \u003cp\u003eLimitations of Our Study: Firstly, due to the rarity of solitary kidney stone patients with this specific type of urolithiasis in clinical practice, our study is a retrospective analysis with a small sample size. Secondly, the clinical data were obtained from a single-center institution, which may result in potential selection bias. Given these limitations, more extensive prospective multicenter studies are needed in the future to further validate our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study identified that elevated urinary white blood cell count, prolonged operative time, and increased postoperative blood white cell count are independent predictors for the occurrence of systemic inflammatory response syndrome (SIRS) in solitary kidney stone patients following percutaneous nephrolithotomy (PCNL).Notably, these predictors are not only common but also easily obtainable through routine clinical testing, spanning the entire treatment process, from preoperative evaluation and intraoperative monitoring to postoperative management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eConflict of interest\u003c/strong\u003e \u003cp\u003eThe authors declare no financial interests are relevant to this work.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e This study was approved by the Institutional Ethics Committee (IEC) of the First Affiliated Hospital of Gannan Medical University.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe Doctoral Research Start-up Fund from the First Affiliated Hospital of Gannan Medical University (QD073). The Technology Plan Project from the Health Commission of Jiangxi Province (202310800). The Technology Research Project from the Health Commission of Ganzhou City (2023-2-088)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contribution Statement:In this study, the specific contributions of each author are as follows:Y. Fang: Led the study design, was responsible for data collection, and the primary drafting of the manuscript.Y. Liu : Participated in the study design, and was in charge of statistical analysis and interpretation of the data.H. Huang : Engaged in data collection and the organization of clinical information.J. Gui : Handled literature searches and authored parts of the theoretical discussion.X. Wang : Assisted in statistical analysis and validated the results.G. Zhang : Participated in the study design and contributed to the interpretation of data and the writing of the discussion section.X. Zou : Responsible for the creation of figures and tables, as well as the visualization of data.T. Xie : Managed the final review and submission of the manuscript.All authors participated in the discussion of the study results, reviewed the manuscript, and agreed on the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data is provided in the manuscript or supplementary information file.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eT\u0026uuml;rk C, Petř\u0026iacute;k A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T (2016) EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol 69:468\u0026ndash;474\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeerapen P, Thongboonkerd V (2023) Kidney Stone Prev Adv Nutr 14:555\u0026ndash;569\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang Z, Fu F, Zhong Z, Zhang L, Xu R, Zhao X (2012) Chinese minimally invasive percutaneous nephrolithotomy for intrarenal stones in patients with solitary kidney: a single-center experience. PLoS ONE 7:e40577\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA (2007) Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. 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Nat Rev Urol 10:598\u0026ndash;605\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMirheydar HS, Palazzi KL, Derweesh IH, Chang DC, Sur RL (2013) Percutaneous nephrolithotomy use is increasing in the United States: an analysis of trends and complications. J Endourol 27:979\u0026ndash;983\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYegenaga I, Hoste E, Van Biesen W, Vanholder R, Benoit D, Kantarci G, Dhondt A, Colardyn F, Lameire N (2004) Clinical characteristics of patients developing ARF due to sepsis/systemic inflammatory response syndrome: results of a prospective study. Am J Kidney Dis 43:817\u0026ndash;824\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N et al (2007) Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes.Clin. J Am Soc Nephrol 2:431\u0026ndash;439\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 113(Suppl 1):5s\u0026ndash;13s\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerry SA, S EH, Ferry BM, Monsen TJ (2015) High Diagnostic Accuracy of Nitrite Test Paired with Urine Sediment can Reduce Unnecessary Antibiotic Therapy. Open Microbiol J 9:150\u0026ndash;159\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Jiang F, Wang Y, Hou Y, Zhang H, Chen Q, Xu N, Lu Z, Hu J, Lu J et al (2012) Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 88:307\u0026ndash;310\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen D, Jiang C, Liang X, Zhong F, Huang J, Lin Y, Zhao Z, Duan X, Zeng G, Wu W (2019) Early and rapid prediction of postoperative infections following percutaneous nephrolithotomy in patients with complex kidney stones. BJU Int 123:1041\u0026ndash;1047\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarraz AM, AR EL-N, Zahran MH, Abol-Enein H (2014) Would the indwelling internal ureteral stent influence renal function despite relief of benign ureteral obstruction?J. Endourol 28:243\u0026ndash;247\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReyner K, Heffner AC, Karvetski CH (2016) Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection.Am. J Emerg Med 34:694\u0026ndash;696\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMilicevic S, Bijelic R, Jakovljevic B (2015) Encrustation of the Ureteral Double J Stent in Patients with a Solitary Functional Kidney - a Case Report. Med Arch 69:265\u0026ndash;268\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLojanapiwat B, Kitirattrakarn P (2011) Role of preoperative and intraoperative factors in mediating infection complication following percutaneous nephrolithotomy. Urol Int 86:448\u0026ndash;452\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen L, Xu QQ, Li JX, Xiong LL, Wang XF, Huang XB (2008) Systemic inflammatory response syndrome after percutaneous nephrolithotomy: an assessment of risk factors. Int J Urol 15:1025\u0026ndash;1028\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoras O, Bozkurt IH, Yonguc T, Degirmenci T, Arslan B, Gunlusoy B, Aydogdu O, Minareci S (2015) Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective. Clin study Urolithiasis 43:55\u0026ndash;60\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkman T, Binbay M, Tekinarslan E, Ozkuvanci U, Kezer C, Erbin A, Berberoglu Y, Yaser-Muslumanoglu A (2011) Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-center. experience Urol 78:272\u0026ndash;276\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWollin DA, Joyce AD, Gupta M, Wong MYC, Laguna P, Gravas S, Gutierrez J, Cormio L, Wang K, Preminger GM (2017) Antibiotic use and the prevention and management of infectious complications in stone disease. World J Urol 35:1369\u0026ndash;1379\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh P, Yadav S, Singh A, Saini AK, Kumar R, Seth A, Dogra PN (2016) Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes. Urol Int 96:207\u0026ndash;211\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQiu Z, Zhan S, Song Y, Huang L, Xie J, Qiu T, Zhao C, Wang L, Li D (2024) Construction and validation of the nomogram predictive model for post-percutaneous nephrolithotomy urinary sepsis. World J Urol 42:135\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeirmengian GK, Zmistowski B, Jacovides C, O'Neil J, Parvizi J (2011) Leukocytosis is common after total hip and knee arthroplasty. Clin Orthop Relat Res 469:3031\u0026ndash;3036\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe Y, Xia D, Tong Y, Shang H, Liu X, Peng E, Huang Q, Tang K, Chen Z (2022) Predictive value of CD3(+) cells and interleukin 2 receptor in systemic inflammatory response syndrome after percutaneous nephrolithotomy. Front Immunol 13:1017219\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBozkurt IH, Aydogdu O, Yonguc T, Koras O, Sen V, Yarimoglu S, Degirmenci T (2015) Predictive Value of Leukocytosis for Infectious Complications. After Percutaneous Nephrolithotomy Urol 86:25\u0026ndash;29\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"urolithiasis","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ures","sideBox":"Learn more about [Urolithiasis](http://link.springer.com/journal/240)","snPcode":"240","submissionUrl":"https://submission.nature.com/new-submission/240/3","title":"Urolithiasis","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Solitary kidney, renal calculi, percutaneous nephrolithotomy (PCNL), leukocyte count","lastPublishedDoi":"10.21203/rs.3.rs-4795877/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4795877/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe purpose of this study is to address the gap in the existing literature regarding the risk factors for systemic inflammatory response syndrome (SIRS) in patients with a solitary kidney who undergo percutaneous nephrolithotomy (PCNL).This retrospective study reviewed the clinical data of 51 patients with solitary kidney stones who underwent PCNL from January 2018 to January 2024.The study evaluated demographic information, stone characteristics, and laboratory data. Among the 51 patients evaluated, 12 (23.5%) developed SIRS. Multivariate analysis showed that a high urinary white blood cell count (p\u0026thinsp;=\u0026thinsp;0.041; OR, 1.004; 95% CI, 1.000-1.008), prolonged operation time (p\u0026thinsp;=\u0026thinsp;0.040; OR, 1.054; 95% CI, 1.005\u0026ndash;1.107), and postoperative blood leukocyte count (p\u0026thinsp;=\u0026thinsp;0.031; OR, 1.459; 95% CI, 1.020\u0026ndash;2.061) were independent risk factors for SIRS after PCNL in patients with a solitary kidney. Given the unique physiological conditions of patients with solitary kidneys, who face a higher incidence of kidney stones and have lower risk tolerance, the results of this study provide insights into the risk factors for SIRS after PCNL in these patients. By identifying these factors, clinicians can better stratify risk, implement preventive and therapeutic measures in a timely manner, reduce the risk of SIRS, and improve overall patient outcomes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e","manuscriptTitle":"Analysis of Risk Factors for SIRS after PCNL in Patients with Solitary Kidney","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-27 11:44:55","doi":"10.21203/rs.3.rs-4795877/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-27T15:50:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-05T18:50:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"199348028767998616663616944807461201242","date":"2024-07-28T18:05:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322144712704574917868333059259884324898","date":"2024-07-27T07:29:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-26T14:36:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-25T13:09:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-25T13:08:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Urolithiasis","date":"2024-07-24T13:46:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"urolithiasis","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ures","sideBox":"Learn more about [Urolithiasis](http://link.springer.com/journal/240)","snPcode":"240","submissionUrl":"https://submission.nature.com/new-submission/240/3","title":"Urolithiasis","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"682e154e-eec7-4e24-a587-0892c911e86f","owner":[],"postedDate":"August 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T16:10:51+00:00","versionOfRecord":{"articleIdentity":"rs-4795877","link":"https://doi.org/10.1007/s00240-024-01681-1","journal":{"identity":"urolithiasis","isVorOnly":false,"title":"Urolithiasis"},"publishedOn":"2024-12-21 15:57:46","publishedOnDateReadable":"December 21st, 2024"},"versionCreatedAt":"2024-08-27 11:44:55","video":"","vorDoi":"10.1007/s00240-024-01681-1","vorDoiUrl":"https://doi.org/10.1007/s00240-024-01681-1","workflowStages":[]},"version":"v1","identity":"rs-4795877","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4795877","identity":"rs-4795877","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}