Angelo Cormio, Daniele Castellani, Domenico De Palma, Ruggiero Fiorella, Runeel Ratnayake, Michele Lotito, Giuseppe Albino, Ugo Giovanni Falagario, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri, Luigi Cormio
{"title":"急性肾损伤作为迷你pcnl后感染并发症的预测因子","authors":"Angelo Cormio, Daniele Castellani, Domenico De Palma, Ruggiero Fiorella, Runeel Ratnayake, Michele Lotito, Giuseppe Albino, Ugo Giovanni Falagario, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri, Luigi Cormio","doi":"10.1002/bco2.70084","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To investigate the incidence, risk factors and clinical consequences of acute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL), with particular focus on its association with postoperative infectious complications.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>A retrospective analysis was conducted on 496 adult patients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025. AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or an absolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively. Patients were stratified into AKI and non-AKI groups. Multivariable logistic regression analyses were performed to identify predictors of AKI development and infectious complications.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Surgery was done in spinal anaesthesia in all cases. AKI occurred in 45 patients (9.1%). There was no difference in median surgical time (52.5 vs 55.0 minutes, p = 0.33) between groups. There was no difference between the two groups in gender distribution, median age, body mass index, baseline serum creatinine, rates of comorbidities and stone features. Patients with AKI had significantly higher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) and longer hospital stays (4 vs 3 days, p < 0.001). Infectious complications were significantly more frequent in the AKI group, with higher median procalcitonin levels (0.21 vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivariable analysis identified previous PCNL (OR 2.51, 95% CI 1.33–4.72, p < 0.01) and higher baseline serum creatinine (OR 2.00, 95% CI 1.07–3.73, p = 0.03) as independent predictors of AKI. AKI was the only independent predictor of infectious complications (OR 3.47, 95% CI 1.04–11.58, p = 0.04).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The strong association between AKI and infectious complications, including potential mortality from sepsis, highlights the clinical significance of this underreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKI following mini-PCNL.</p>\n </section>\n </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70084","citationCount":"0","resultStr":"{\"title\":\"Acute kidney injury as a predictor of infectious complications after mini-PCNL\",\"authors\":\"Angelo Cormio, Daniele Castellani, Domenico De Palma, Ruggiero Fiorella, Runeel Ratnayake, Michele Lotito, Giuseppe Albino, Ugo Giovanni Falagario, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri, Luigi Cormio\",\"doi\":\"10.1002/bco2.70084\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To investigate the incidence, risk factors and clinical consequences of acute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL), with particular focus on its association with postoperative infectious complications.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Materials and Methods</h3>\\n \\n <p>A retrospective analysis was conducted on 496 adult patients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025. AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or an absolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively. Patients were stratified into AKI and non-AKI groups. Multivariable logistic regression analyses were performed to identify predictors of AKI development and infectious complications.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Surgery was done in spinal anaesthesia in all cases. AKI occurred in 45 patients (9.1%). There was no difference in median surgical time (52.5 vs 55.0 minutes, p = 0.33) between groups. There was no difference between the two groups in gender distribution, median age, body mass index, baseline serum creatinine, rates of comorbidities and stone features. Patients with AKI had significantly higher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) and longer hospital stays (4 vs 3 days, p < 0.001). Infectious complications were significantly more frequent in the AKI group, with higher median procalcitonin levels (0.21 vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivariable analysis identified previous PCNL (OR 2.51, 95% CI 1.33–4.72, p < 0.01) and higher baseline serum creatinine (OR 2.00, 95% CI 1.07–3.73, p = 0.03) as independent predictors of AKI. AKI was the only independent predictor of infectious complications (OR 3.47, 95% CI 1.04–11.58, p = 0.04).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>The strong association between AKI and infectious complications, including potential mortality from sepsis, highlights the clinical significance of this underreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKI following mini-PCNL.</p>\\n </section>\\n </div>\",\"PeriodicalId\":72420,\"journal\":{\"name\":\"BJUI compass\",\"volume\":\"6 9\",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-09-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70084\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BJUI compass\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.70084\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJUI compass","FirstCategoryId":"1085","ListUrlMain":"https://bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.70084","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的探讨微创经皮肾镜取石术（mini-PCNL）后急性肾损伤（AKI）的发生率、危险因素及临床后果，并探讨其与术后感染并发症的关系。材料与方法对2020年2月至2025年4月期间接受mini-PCNL （22 Ch）治疗的496例成人患者进行回顾性分析。根据KDIGO标准，AKI定义为术后72小时内血清肌酐升高≥1.5倍或绝对升高≥0.3 mg/dl。将患者分为AKI组和非AKI组。进行多变量logistic回归分析以确定AKI发展和感染并发症的预测因素。结果所有病例均行脊髓麻醉手术。45例（9.1%）发生AKI。两组间中位手术时间无差异（52.5 vs 55.0分钟，p = 0.33）。两组在性别分布、中位年龄、体重指数、基线血清肌酐、合并症发生率和结石特征方面无差异。AKI患者的总体术后并发症发生率明显更高（24.4% vs 7.1%, p < 0.001），住院时间也更长（4天vs 3天，p < 0.001）。AKI组感染并发症明显更频繁，降钙素原中位水平更高（0.21 vs 0.06 ng/ml, p = 0.03）。AKI组中有1例患者死于败血症。多变量分析发现，既往PCNL （OR 2.51, 95% CI 1.33-4.72, p < 0.01）和较高的基线血清肌酐（OR 2.00, 95% CI 1.07-3.73, p = 0.03）是AKI的独立预测因子。AKI是感染并发症的唯一独立预测因子（OR 3.47, 95% CI 1.04-11.58, p = 0.04）。AKI与感染性并发症（包括脓毒症的潜在死亡率）之间的密切关联突出了这种未被报道的并发症的临床意义。对于mini-PCNL后发生AKI的患者，加强围手术期监测和积极处理感染并发症是必要的。
Acute kidney injury as a predictor of infectious complications after mini-PCNL
Objective
To investigate the incidence, risk factors and clinical consequences of acute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL), with particular focus on its association with postoperative infectious complications.
Materials and Methods
A retrospective analysis was conducted on 496 adult patients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025. AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or an absolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively. Patients were stratified into AKI and non-AKI groups. Multivariable logistic regression analyses were performed to identify predictors of AKI development and infectious complications.
Results
Surgery was done in spinal anaesthesia in all cases. AKI occurred in 45 patients (9.1%). There was no difference in median surgical time (52.5 vs 55.0 minutes, p = 0.33) between groups. There was no difference between the two groups in gender distribution, median age, body mass index, baseline serum creatinine, rates of comorbidities and stone features. Patients with AKI had significantly higher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) and longer hospital stays (4 vs 3 days, p < 0.001). Infectious complications were significantly more frequent in the AKI group, with higher median procalcitonin levels (0.21 vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivariable analysis identified previous PCNL (OR 2.51, 95% CI 1.33–4.72, p < 0.01) and higher baseline serum creatinine (OR 2.00, 95% CI 1.07–3.73, p = 0.03) as independent predictors of AKI. AKI was the only independent predictor of infectious complications (OR 3.47, 95% CI 1.04–11.58, p = 0.04).
Conclusions
The strong association between AKI and infectious complications, including potential mortality from sepsis, highlights the clinical significance of this underreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKI following mini-PCNL.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
