To identify the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to provide clues for early detection of SIRS after PCNL.

A total of 151 patients who underwent first-stage PCNL in our institute between July 2016 and June 2020 were retrospectively reviewed. All the procedures were performed with 18 F tract using an irrigation pump setting the irrigation fluid pressure at 110 mmHg and the flow rate of irrigation at 0.4 L/min. According to the occurrence of SIRS, the patients were divided into SIRS group and non SIR group. The clinical data of the two groups were analyzed.

24 patients (15.9%) developed to SIRS and only 1 patients (0.66%) progressed to severe urinary sepsis. The results of univariate analysis showed that the stone size, operative time, history of DM, history of ipsilateral surgery, preoperative urine culture, staghorn calculi, stone culture, number of tracts, and blood transfusion were found to have a significant correlation with post-PCNL SIRS (P<0.05). In multivariate analysis, the stone size (OR=4.968, P=0.005), preoperative urine culture (OR=8.232, P=0.036), stone culture (OR=20.389, P<0.001), the number of tracts (OR=14.673, P<0.001), blood transfusion (OR=46.062, P<0.001) were indentified as the independent risk factors for post-PCNL SIRS.

Large load kidney stone, positive preoperative urine culture, positive stone culture, multiple tracts, receipt of a blood transfusion are the independent risk factors for post-PCNL SIRS. More attention should be paid when the PCNL patients have these risk factors.