การพัฒนาแบบจำลองทำนายกลุ่มอาการอักเสบทั่วร่างกาย หลังการผ่าตัด รักษานิ่วในไตด้วยวิธีส่องกล้องผ่านผิวหนังเพื่อสลายนิ่วที่โรงพยาบาลน่าน

Nattawit Jakjaroenrit

Authors

Nattawit Jakjaroenrit Department of Surgery, Nan Hospital

Keywords:

Renal calculi, percutaneous nephrolithotomy, postoperative complications, systemic inflammatory response syndrome, urinary tract infection

Abstract

Objective: This study aimed to identify risk factors associated with the development of SIRS following PCNL and to develop a predictive model for early identification of SIRS following PCNL.
Methods: A retrospective analytical study was conducted on 309 patients who underwent PCNL for renal calculi at Nan Hospital between October 1, 2020, and October 30, 2024. The sample size was estimated by achieve 80% statistical power and 5% alpha error. Categorical variables were analyzed using the chi-square test, and continuous variables were compared using Student’s t-test. Variables with statistically significant differences were included in a multivariable logistic regression model to identify independent predictors of SIRS. A nomogram was constructed based on the final model to assist in clinical risk prediction, with efforts to minimize overfitting.
Results: Among the 309 patients, 36.2% developed SIRS postoperatively. Significant predictors of SIRS included diabetes mellitus (OR 2.36; 95% CI 1.29 – 4.32, p = 0.005), stone size≥3 cm (OR 2.58; 95% CI 1.4 – 4.75, p = 0.002), the presence of ≥10 white blood cells per high-power field in preoperative urine analysis (OR 2.7, 95 % CI 1 – 4.28, p = 0.044), and positive preoperative urine culture (OR 12.93, 95% CI 6.98 – 23.97, p<0.001)
Conclusions: Diabetes mellitus, large stone size (≥3 cm), positive preoperative urine culture, and pyuria were significantly associated with the development of SIRS after PCNL. These factors can be integrated into a predictive tool to support early risk assessment and guide perioperative management strategies.

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