术前尿培养阴性患者PCNL术后尿路感染的预测模型构建

doi:10.3877/cma.j.issn.1674-3253.2025.06.014

目的

本研究旨在探讨术前尿培养阴性患者在接受经皮肾镜取石术（PCNL）后发生感染的风险因素，并构建预测模型。

方法

本研究共纳入了2020年1月至2023年12月在本院接受PCNL治疗且术前尿培养阴性的278例患者。收集患者的临床资料，包括年龄、性别、体质量指数、糖尿病、高血压、结石特征、肾积水及术中相关信息等。通过多变量Logistic回归分析，筛选术后尿路感染相关的独立危险因素，并基于这些因素构建预测模型。

结果

结石患者中术后尿路感染发生率为11.9%（33/278）。结石负荷≥500 m²（OR=3.07，P=0.035）、肾积水（OR=1.34，P=0.034）、尿白细胞阳性（OR=31.50，P<0.001）是术后尿路感染的独立危险因素。基于以上3个因素建立预测模型的ROC曲线下面积（AUC）为0.89。

结论

结石负荷较大、肾积水及尿白细胞阳性的术前尿培养阴性患者在PCNL术后发生感染的风险较高，所构建的预测模型可作为术前感染风险评估工具。

关键词: 肾结石, 经皮肾镜（PCNL）, 尿路感染, 预测模型

Objective

This study aimed to investigate risk factors for urinary infection in patients with negative preoperative urine culture after percutaneous nephrolithotomy (PCNL) and to develop a predictive model to assist clinicians in preoperative assessment of infection risk.

Methods

278 patients with negative preoperative urine cultures who underwent PCNL in our hospital from January 2020 to December 2023 were included. Clinical data, including age, sex, body mass index (BMI), diabetes, hypertension, stone characteristics, hydronephrosis, and intraoperative parameters were collected. Multivariate logistic regression analysis was performed to identify independent risk factors for postoperative urinary infection. A predictive model was subsequently constructed based on these factors.

Results

The incidence of postoperative urinary infection was 11.9% (33/278). Univariate analysis revealed that female sex, larger stone burden, hydronephrosis, and positive urine white blood cells (WBCs) were significantly associated with postoperative urinary infection (P<0.05). Multivariate analysis identified stone burden≥500 m² (OR=3.07, P=0.035), hydronephrosis (OR=1.34, P=0.034), and positive urine WBCs (OR=31.50, P<0.001) as independent risk factors for postoperative urinary infection. The predictive model demonstrated excellent discriminatory performance, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.89.

Conclusion

Patients with negative preoperative urine culture remain at risk of postoperative infection following PCNL, particularly those with larger stone burden, hydronephrosis, or positive urine WBCs. The predictive model provides clinicians with a practical tool for preoperative infection risk stratification.

Key words: Kidney stones, Percutaneous nephrolithotomy, Urinary infection, Predictive model

表1 PCNL术后尿路感染组与非感染组患者资料对比[例(%)]

变量	非感染组(n=245)	感染组(n=33)	χ²值	P值
年龄(岁)			0.96	0.328
≥60	72 (29.39)	7 (21.21)
< 60	173 (70.61)	26 (78.79)
性别			11.00	<0.001
男性	162 (66.12)	12 (36.36)
女性	83 (33.88)	21 (63.64)
体质量指数(kg/m²)			-	0.898
>20，≤25	139 (56.73)	21 (63.64)
≤20	30 (12.24)	4 (12.12)
≥25，<30	60 (24.49)	7 (21.21)
≥30	16 (6.53)	1 (3.03)
高血压			2.14	0.143
无	197 (80.41)	30 (90.91)
有	48 (19.59)	3 (9.09)
糖尿病			<0.001	>0.999
无	229 (93.47)	31 (93.94)
有	16 (6.53)	2 (6.06)
同侧手术史			0.49	0.482
无	187 (76.33)	27 (81.82)
有	58 (23.67)	6 (18.18)
结石分布			4.34	0.037
单发	129 (52.65)	11 (33.33)
多发	116 (47.35)	22 (66.67)
结石负荷(mm²)			9.28	0.002
< 500	150 (61.22)	11 (33.33)
≥500	95 (38.78)	22 (66.67)
肾积水			4.06	0.044
无	96 (39.18)	19 (57.58)
有	149 (60.82)	14 (42.42)
血白细胞			0.42	0.809
正常	173 (70.61)	25 (75.76)
高于正常	48 (19.59)	5 (15.15)
低于正常	24 (9.80)	3 (9.09)
血中性粒细胞			4.04	0.132
正常	170 (69.39)	25 (75.76)
低于正常	14 (5.71)	4 (12.12)
高于正常	61 (24.90)	4 (12.12)
血红蛋白			3.39	0.066
低于正常	36 (14.69)	9 (27.27)
正常	209 (85.31)	24 (72.73)
尿白细胞			57.55	<0.001
阴性	184 (75.10)	3 (9.09)
阳性	61 (24.90)	30 (90.91)
尿亚硝酸盐			0.18	0.667
阴性	225 (91.84)	29 (87.88)
阳性	20 (8.16)	4 (12.12)
尿白细胞酯酶			0.49	0.486
阴性	225 (91.84)	32 (96.97)
阳性	20 (8.16)	1 (3.03)
ASA分级			1.07	0.302
1~2级	210 (85.71)	31 (93.94)
3~4级	35 (14.29)	2 (6.06)
手术时间(min)			0.04	0.838
< 90	116 (47.35)	15 (45.45)
≥90	129 (52.65)	18 (54.55)
术中低血压			5.87	0.015
无	214 (87.35)	23 (69.70)
有	31 (12.65)	10 (30.30)

表1 PCNL术后尿路感染组与非感染组患者资料对比[例(%)]

变量	非感染组(n=245)	感染组(n=33)	χ²值	P值
年龄(岁)			0.96	0.328
≥60	72 (29.39)	7 (21.21)
< 60	173 (70.61)	26 (78.79)
性别			11.00	<0.001
男性	162 (66.12)	12 (36.36)
女性	83 (33.88)	21 (63.64)
体质量指数(kg/m²)			-	0.898
>20，≤25	139 (56.73)	21 (63.64)
≤20	30 (12.24)	4 (12.12)
≥25，<30	60 (24.49)	7 (21.21)
≥30	16 (6.53)	1 (3.03)
高血压			2.14	0.143
无	197 (80.41)	30 (90.91)
有	48 (19.59)	3 (9.09)
糖尿病			<0.001	>0.999
无	229 (93.47)	31 (93.94)
有	16 (6.53)	2 (6.06)
同侧手术史			0.49	0.482
无	187 (76.33)	27 (81.82)
有	58 (23.67)	6 (18.18)
结石分布			4.34	0.037
单发	129 (52.65)	11 (33.33)
多发	116 (47.35)	22 (66.67)
结石负荷(mm²)			9.28	0.002
< 500	150 (61.22)	11 (33.33)
≥500	95 (38.78)	22 (66.67)
肾积水			4.06	0.044
无	96 (39.18)	19 (57.58)
有	149 (60.82)	14 (42.42)
血白细胞			0.42	0.809
正常	173 (70.61)	25 (75.76)
高于正常	48 (19.59)	5 (15.15)
低于正常	24 (9.80)	3 (9.09)
血中性粒细胞			4.04	0.132
正常	170 (69.39)	25 (75.76)
低于正常	14 (5.71)	4 (12.12)
高于正常	61 (24.90)	4 (12.12)
血红蛋白			3.39	0.066
低于正常	36 (14.69)	9 (27.27)
正常	209 (85.31)	24 (72.73)
尿白细胞			57.55	<0.001
阴性	184 (75.10)	3 (9.09)
阳性	61 (24.90)	30 (90.91)
尿亚硝酸盐			0.18	0.667
阴性	225 (91.84)	29 (87.88)
阳性	20 (8.16)	4 (12.12)
尿白细胞酯酶			0.49	0.486
阴性	225 (91.84)	32 (96.97)
阳性	20 (8.16)	1 (3.03)
ASA分级			1.07	0.302
1~2级	210 (85.71)	31 (93.94)
3~4级	35 (14.29)	2 (6.06)
手术时间(min)			0.04	0.838
< 90	116 (47.35)	15 (45.45)
≥90	129 (52.65)	18 (54.55)
术中低血压			5.87	0.015
无	214 (87.35)	23 (69.70)
有	31 (12.65)	10 (30.30)

表2 Logistic回归分析PCNL术后尿路感染危险因素[例(%)]

变量	单因素		多因素
变量	OR (95%CI)	P值	OR (95%CI)	P值
年龄(岁)
≥60	1.00
< 60岁	0.82 (0.31~2.17)	0.690
性别
男性	1.00
女性	2.73 (1.18~6.33)	0.019
体质量指数(kg/m²)
>20，≤25	1.00
≤20	1.03 (0.31~3.35)	0.965
≥25，<30	1.72 (0.25~2.10)	0.552
≥30	0.00 (0.00~Inf)	0.989
高血压
无	1.00
有	0.33 (0.07~1.46)	0.143
糖尿病
无	1.00
有	1.19 (0.25~5.70)	0.828
同侧手术史
无	1.00
有	0.71 (0.25~2.01)	0.524
结石分布
单发	1.00
多发	1.98 (0.84~4.69)	0.120
结石负荷(mm²)
< 500	1.00		1.00
≥500	3.99 (1.59~10.01)	0.003	3.07 (1.09~8.70)	0.035
肾积水
无	1.00		1.00
有	1.40 (1.17~1.94)	0.037	1.34 (1.13~1.92)	0.034
血白细胞
正常	1.00
高于正常	2.27 (0.41~12.55)	0.349
低于正常	1.90 (0.53~6.80)	0.321
血中性粒细胞
正常	1.00
低于正常	0.68 (0.18~2.65)	0.580
高于正常	0.17 (0.02~1.12)	0.066
血红蛋白
低于正常	1.00
正常	0.57 (0.22~1.47)	0.243
尿白细胞
阴性	1.00		1.00
阳性	31.83 (7.23~140.02)	<0.001	31.50 (6.95~142.90)	<0.001
尿亚硝酸盐
阴性	1.00
阳性	2.87 (0.83~9.95)	0.096
尿白细胞酯酶
阴性	1.00
阳性	0.48 (0.06~3.81)	0.485
ASA分级
1~2级	1.00
3~4级	0.19 (0.02~1.47)	0.112
手术时间(min)
< 90	1.00
≥90	1.10 (0.48~2.54)	0.824
术中低血压
无	1.00
有	2.32 (0.88~6.14)	0.089

表2 Logistic回归分析PCNL术后尿路感染危险因素[例(%)]

变量	单因素		多因素
变量	OR (95%CI)	P值	OR (95%CI)	P值
年龄(岁)
≥60	1.00
< 60岁	0.82 (0.31~2.17)	0.690
性别
男性	1.00
女性	2.73 (1.18~6.33)	0.019
体质量指数(kg/m²)
>20，≤25	1.00
≤20	1.03 (0.31~3.35)	0.965
≥25，<30	1.72 (0.25~2.10)	0.552
≥30	0.00 (0.00~Inf)	0.989
高血压
无	1.00
有	0.33 (0.07~1.46)	0.143
糖尿病
无	1.00
有	1.19 (0.25~5.70)	0.828
同侧手术史
无	1.00
有	0.71 (0.25~2.01)	0.524
结石分布
单发	1.00
多发	1.98 (0.84~4.69)	0.120
结石负荷(mm²)
< 500	1.00		1.00
≥500	3.99 (1.59~10.01)	0.003	3.07 (1.09~8.70)	0.035
肾积水
无	1.00		1.00
有	1.40 (1.17~1.94)	0.037	1.34 (1.13~1.92)	0.034
血白细胞
正常	1.00
高于正常	2.27 (0.41~12.55)	0.349
低于正常	1.90 (0.53~6.80)	0.321
血中性粒细胞
正常	1.00
低于正常	0.68 (0.18~2.65)	0.580
高于正常	0.17 (0.02~1.12)	0.066
血红蛋白
低于正常	1.00
正常	0.57 (0.22~1.47)	0.243
尿白细胞
阴性	1.00		1.00
阳性	31.83 (7.23~140.02)	<0.001	31.50 (6.95~142.90)	<0.001
尿亚硝酸盐
阴性	1.00
阳性	2.87 (0.83~9.95)	0.096
尿白细胞酯酶
阴性	1.00
阳性	0.48 (0.06~3.81)	0.485
ASA分级
1~2级	1.00
3~4级	0.19 (0.02~1.47)	0.112
手术时间(min)
< 90	1.00
≥90	1.10 (0.48~2.54)	0.824
术中低血压
无	1.00
有	2.32 (0.88~6.14)	0.089

图1 术前尿培养阳性患者PCNL术后尿路感染的列线图预测模型

图2 术前尿培养阴性患者术后尿路感染的列线图预测模型验证注：a为临床预测模型的ROC曲线；b为决策曲线图评估预测模型的临床实用性；c为预测模型校准曲线提示模型预测值与实际观测值之间具有良好的一致性

[1]	Shastri S, Patel J, Sambandam KK, et al. Kidney stone pathophysiology, evaluation and management: core curriculum 2023[J]. Am J Kidney Dis, 2023, 82(5): 617-634. DOI: 10.1053/j.ajkd.2023.03.017.
[2]	Shahait M, Farkouh A, Mucksavage P, et al. Outcome of mini-PCNL under loco-regional anesthesia: outcomes of a systematic review[J]. Curr Urol Rep, 2023, 24(9): 417-426. DOI: 10.1007/s11934-023-01169-2.
[3]	Lai WS, Assimos D. Factors associated with postoperative infection after percutaneous nephrolithotomy[J]. Rev Urol, 2018, 20(1): 7-11. DOI: 10.3909/riu0778.
[4]	Han Y, Gao W, Wang B, et al. Risk factor analysis for infection and bleeding after lateral decubitus percutaneous nephrolithotomy[J]. Medicine, 2023, 102(47): e35845. DOI: 10.1097/MD.0000000000035845.
[5]	Tang Y, Zhang C, Mo C, et al. Predictive model for systemic infection after percutaneous nephrolithotomy and related factors analysis[J]. Front Surg, 2021, 8: 696463. DOI: 10.3389/fsurg.2021.696463.
[6]	Zeng G, Mai Z, Xia S, et al. Prevalence of kidney stones in China: an ultrasonography based cross-sectional study[J]. BJU Int, 2017, 120(1): 109-116. DOI: 10.1111/bju.13828.
[7]	俞蔚文, 张大宏, 何翔, 等. 联合不同口径多通道经皮肾镜取石术治疗复杂性肾结石[J]. 中国微创外科杂志, 2013, 13(9): 820-823. DOI: 10.3969/j.issn.1009-6604.2013.09.016.
[8]	Wu H, Zhu S, Yu S, et al. Early drastic decrease in white blood count can predict uroseptic shock induced by upper urinary tract endoscopic lithotripsy: a translational study[J]. J Urol, 2015, 193(6): 2116-2122. DOI: 10.1016/j.juro.2015.01.071.
[9]	Zanetti G, Paparella S, Trinchieri A, et al. Infections and urolithiasis: current clinical evidence in prophylaxis and antibiotic therapy[J]. Arch Ital Urol Androl, 2008, 80(1): 5-12.
[10]	O'Keeffe NK, Mortimer AJ, Sambrook PA, et al. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones[J]. Br J Urol, 1993, 72(3): 277-283. DOI: 10.1111/j.1464-410x.1993.tb00717.x.
[11]	Fernandez A, Foell K, Nott L, et al. Percutaneous nephrolithotripsy in patients with urinary diversions: a case-control comparison of perioperative outcomes[J]. J Endourol, 2011, 25(10): 1615-1618. DOI: 10.1089/end.2011.0045.
[12]	Gutierrez J, Smith A, Geavlete P, et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy[J]. World J Urol, 2013, 31(5): 1135-1140. DOI: 10.1007/s00345-012-0836-y.
[13]	Kumar S, Bag S, Ganesamoni R, et al. Risk factors for urosepsis following percutaneous nephrolithotomy: role of 1 week of nitrofurantoin in reducing the risk of urosepsis[J]. Urol Res, 2012, 40(1): 79-86. DOI: 10.1007/s00240-011-0386-6.
[14]	Wang Y, Jiang F, Wang Y, et al. Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors[J]. Urol Int, 2012, 88(3): 307-310. DOI: 10.1159/000336164.
[15]	Peng L, Zhong W. RE: The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy[J]. World J Urol, 2020, 38(12): 3297. DOI: 10.1007/s00345-020-03088-0.
[16]	Agha R, Abdall-Razak A, Crossley E, et al. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery[J]. Int J Surg, 2019, 72: 156-165. DOI: 10.1016/j.ijsu.2019.11.002.
[17]	Talizin TB, Danilovic A, Torricelli FCM, et al. Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis[J]. Int Braz J Urol, 2024, 50(2): 152-163. DOI: 10.1590/S1677-5538.IBJU.2023.0626.
[18]	Patel K, Batura D. An overview of hydronephrosis in adults[J]. Br J Hosp Med, 2020, 81(1): 1-8. DOI: 10.12968/hmed.2019.0274.
[19]	Yang Z, Lin D, Hong Y, et al. The effect of preoperative urine culture and bacterial species on infection after percutaneous nephrolithotomy for patients with upper urinary tract stones[J]. Sci Rep, 2022, 12(1): 4833. DOI: 10.1038/s41598-022-08913-7.
[20]	Chow WH, Lindblad P, Gridley G, et al. Risk of urinary tract cancers following kidney or ureter stones[J]. J Natl Cancer Inst, 1997, 89(19): 1453-1457. DOI: 10.1093/jnci/89.19.1453.
[21]	Ferry SA, E Holm S, Ferry BM, et al. High diagnostic accuracy of nitrite test paired with urine sediment can reduce unnecessary antibiotic therapy[J]. Open Microbiol J, 2015, 9: 150-159. DOI: 10.2174/1874285801509010150.
[22]	Yang T, Liu S, Hu J, et al. The evaluation of risk factors for postoperative infectious complications after percutaneous nephrolithotomy[J]. Biomed Res Int, 2017, 2017: 4832051. DOI: 10.1155/2017/4832051.
[23]	Xu H, Hu L, Wei X, et al. The predictive value of preoperative high-sensitive C-reactive protein/albumin ratio in systemic inflammatory response syndrome after percutaneous nephrolithotomy[J]. J Endourol, 2019, 33(1): 1-8. DOI: 10.1089/end.2018.0632.
[24]	Rashid AO, Fakhulddin SS. Risk factors for fever and sepsis after percutaneous nephrolithotomy[J]. Asian J Urol, 2016, 3(2): 82-87. DOI: 10.1016/j.ajur.2016.03.001.
[25]	Koras O, Bozkurt IH, Yonguc T, et al. Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study[J]. Urolithiasis, 2015, 43(1): 55-60. DOI: 10.1007/s00240-014-0730-8.
[26]	Wolf JS, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis[J]. J Urol, 2008, 179(4): 1379-1390. DOI: 10.1016/j.juro.2008.01.068.
[27]	Potretzke AM, Park AM, Bauman TM, et al. Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?[J]. Investig Clin Urol, 2016, 57(6): 417-423. DOI: 10.4111/icu.2016.57.6.417.

[1]	明昊, 宋宏萍, 白誉誉, 党晓智, 赵阳, 程燕妮, 王琪, 肖迎聪. 自动乳腺超声联合临床病理特征预测Luminal B 型乳腺癌术后复发风险的临床研究[J/OL]. 中华医学超声杂志（电子版）, 2025, 22(04): 337-347.
[2]	戴辉水, 吕嵩, 张劲松, 巴根, 石齐芳. 基于机器学习算法构建药物中毒患者ICU住院时间延长的预测模型[J/OL]. 中华危重症医学杂志(电子版), 2025, 18(04): 274-281.
[3]	李培真, 刘海亮, 李大伟, 贾昊, 张泽瑾, 刘力维, 申传安. 重度烧伤患者发生早期急性肾损伤危险因素分析及预测模型建立[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(03): 199-205.
[4]	张丽花, 胡耀华, 周春献, 张晓亭, 胡韶军. 恶性肿瘤患者住院化疗期间医院感染状况及列线图预测模型构建[J/OL]. 中华实验和临床感染病杂志(电子版), 2025, 19(04): 205-213.
[5]	李炜, 王倩, 张娥, 张光辉. 基于血清降钙素原、可溶性白细胞介素-2受体及临床特征建立慢性化脓性中耳炎术后复发风险预测模型及效能评价[J/OL]. 中华实验和临床感染病杂志(电子版), 2025, 19(04): 223-229.
[6]	孙圣梅, 习一清, 安宁. 人表皮生长因子受体2阳性型乳腺癌新辅助治疗响应的基因预测模型[J/OL]. 中华普通外科学文献(电子版), 2025, 19(05): 332-339.
[7]	赵晨皓, 张序东, 杨浚沫, 周何. 血清肿瘤标志物对结直肠癌患者术后复发的预测效能研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 467-470.
[8]	陶然, 尹聪, 叶少波, 杨新平, 田洁, 熊丽红, 吴瑾滨, 梅红兵. 应用多学科管理预防日间经皮肾镜碎石取石术后尿源性脓毒症的发生[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(05): 615-621.
[9]	林水荣, 宋子敏, 于玺, 李绍强, 华赟鹏, 沈顺利. 术前抗病毒治疗对HBV相关肝癌肝切除术后肝衰竭影响[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(05): 700-706.
[10]	赵俊宇, 林航宇, 李会灵, 王显飞, 游川. 肝癌肝切除术后大量腹水预测模型的建立与验证[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(05): 740-747.
[11]	王柯云, 孙雅佳, 李甜, 张钰哲, 郑颖, 张伟光, 王倩, 董哲毅. 糖尿病肾脏疾病早期发生风险预测模型的研究进展[J/OL]. 中华肾病研究电子杂志, 2025, 14(04): 218-225.
[12]	李曰平, 鞠倩, 张汝梦, 韩博. 基于CT影像组学预测胃癌根治术复发风险的临床研究[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(05): 460-466.
[13]	李姁, 冯中秋. HBV相关原发性肝癌患者经导管动脉化疗栓塞术后严重腹痛预测模型的构建及验证[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(05): 480-485.
[14]	再米拉·依力哈木, 蒋升, 艾比拜·玉素甫. SGLT2抑制剂与肾结石风险：一项荟萃分析[J/OL]. 中华临床医师杂志(电子版), 2025, 19(06): 446-453.
[15]	张帆娟, 韩勇, 周力, 曾珊, 雷景恒, 李舒雅, 周岳杰, 邓哲. STEMI患者PCI术后院内死亡预测模型构建及验证[J/OL]. 中华卫生应急电子杂志, 2025, 11(03): 133-139.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Development of a predictive model for urinary infection in patients with negative preoperative urine culture after percutaneous nephrolithotomy

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Development of a predictive model for urinary infection in patients with negative preoperative urine culture after percutaneous nephrolithotomy