Can we identify the risk factors for SIRS/sepsis after percutaneous nephrolithotomy? A meta‑analysis and literature review

Abstract

With the increase in percutaneous interventions such as percutaneous nephrolithotomy (PCNL) for renal lithiasis, infectious complications are becoming more frequent. The present study performed a systematic Medline and Embase databases search, using the following words: 'PCNL' [MeSH Terms] AND ['sepsis' (All Fields) OR 'PCNL' (All Fields)] AND ['septic shock' (All Fields)] AND ['urosepsis' (MeSH Terms) OR 'Systemic inflammatory response syndrome (SIRS)' (All Fields)]. Because of the technological advances in endourology, articles published between 2012 and 2022 were searched. Of the 1,403 results of the search, only 18 articles, representing 7,507 patients in which PCNL was performed, met the criteria to be included in the analysis. All authors applied antibiotic prophylaxis to all patients and, in some cases, the infection was treated preoperatively in those with positive urine cultures. According to the analysis of the present study, the operative time has been significantly longer in patients who developed SIRS/sepsis post-operatively (P=0.0001) with the highest heterogeneity (I²=91%) compared with other factors. Patients with a positive preoperative urine culture had a significantly higher risk of developing SIRS/sepsis following PCNL (P=0.00001), OD=2.92 (1.82, 4.68) and there was also a high degree of heterogeneity (I²=80%). Performing a multi-tract PCNL also increased the incidence of postoperative SIRS/sepsis (P=0.00001), OD=2.64 (1.78, 3.93) and the heterogeneity was a little smaller (I²=67%). Diabetes mellitus (P=0.004), OD=1.50 (1.14, 1.98), I²=27% and preoperative pyuria (P=0.002), OD=1.75 (1.23, 2.49), I²=20%, were other factors that significantly influenced postoperative evolution. A total of two factors analyzed, body mass index and patient's age, did not influence the outcome, P=0.45, I²=58% and P=0.98, I²=63%.

Keywords: percutaneous nephrolithotomy; pyuria; risk factor; sepsis; urine culture.

Figure 1

PRISMA flowchart of the study selection. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PCNL, percutaneous nephrolithotomy.

Figure 2

Forest plot showing factors influencing the PCNL outcome (Diabetes mellitus, multitract PCNL, preoperative pyuria, operative time and positive preoperative urine culture). Black diamonds indicate study weight. Green squares indicate the overall result. Horizontal lines indicate the 95% confidence interval. CI, confidence interval; df, degrees of freedom; Random, random effects model; SD, standard deviation; PCNL, percutaneous nephrolithotomy; SIRS, Systemic inflammatory response syndrome.

Figure 3

Forest plot showing factors that did not influence the PCNL outcome (BMI and patient's age). Black diamonds indicate study weight. Green squares indicate the overall result. Horizontal lines indicate the 95% confidence interval. PCNL, percutaneous nephrolithotomy; BMI, body mass index; CI, confidence interval; df, degrees of freedom; Random, random effects model; SD, standard deviation; SIRS, Systemic inflammatory response syndrome.