A retrospective cohort study of risk factors in patients with urosepsis complicating upper urinary tract stones after surgery

doi:10.3877/cma.j.issn.1674-3253.2026.02.007

Abstract

Abstract:

Objective

To explore the clinical characteristics of ICU treatment requirements and shock occurrence in patients with urosepsis after upper urinary tract stone surgery, identify high-risk factors, and provide evidence for early assessment and precise intervention.

Methods

Clinical data of 36 cases who developed urosepsis after PCNL for upper urinary tract stone from January 2020 to June 2023 were retrospectively collected. Demographic characteristics, laboratory and imaging parameters, treatment processes, and outcomes were compared between ICU group (n=7) and non-ICU group (n=29), shock group (n=23) and non-shock group (n=13), as well as non-ICU shock subgroup (n=17) and non-shock subgroup (n=12).

Results

Compared with the non-ICU group, the ICU group had higher preoperative neutrophil count [(6.03±2.39) vs (4.12±1.99)×10⁹/L, P=0.035] and percentage[(70.73%±13.44%) vs (59.12%±12.81%), P=0.042], higher preoperative serum creatinine [177.29 (17.01, 337.57) vs 86.72 (38.71, 134.74) μmol/L, P=0.008], lower postoperative hemoglobin [(91.29±19.52) vs (108.00±16.87) g/L,P=0.030], and lower systolic blood pressure [(95.43±17.94) vs (110.55±16.58) mmHg, P=0.042]. The shock group had significantly higher stone CT values than the non-shock group [(1 170.55±265.55) vs (905.69±302.91) Hu, P=0.010], and a higher proportion of high-density stones (CT value >1 000 Hu)(73.91% vs 30.77%, P=0.012). Hemodynamically, the shock group had lower systolic blood pressure [(100.35±15.99) vs (120.46±12.69) mmHg, P<0.001], higher shock index [(1.25±0.19) vs (0.84±0.10), P<0.001], and higher quick sequential organ failure assessment (qSOFA) score [(2.52±0.51) vs (2.15±0.38), P=0.030]. In the non-ICU group, shock patients had lower preoperative neutrophil count [(3.45±1.31) vs (5.07±2.42)×10⁹/L, P=0.027] and percentage [(54.41%±9.52%) vs (65.78%±14.26%), P=0.016] than non-shock patients.

Conclusions

Abnormal neutrophil count and ratio, renal dysfunction, decreased hemoglobin, and circulatory instability are important indicators for assessing ICU treatment requirements. High stone density, hemodynamic abnormalities, and elevated qSOFA score contribute to early identification of shock risk.

Key words: Urosepsis, Upper urinary tract stones, Septic shock, ICU

Xiao Li, Xiaolong Pan, Jianzhou Cheng, Shizhong Zhang, Guangjian Zhu, Ziliang Deng, Fanyu Wu. A retrospective cohort study of risk factors in patients with urosepsis complicating upper urinary tract stones after surgery[J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(02): 165-170.

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References 27

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组别	例数	术前中性粒细胞计数[×10⁹/L，(±s)]	术前中性粒细胞百分比[%，(±s)]	术前血肌酐[μmol/L，M(Q)]	术后血红蛋白[g/L，(±s)]
非ICU组	29	4.12±1.99	59.12±12.81	86.72（38.71，134.74）	108.00±16.87
ICU组	7	6.03±2.39	70.73±13.44	177.29（17.01，337.57）	91.29±19.52
统计值		t=2.178	t=2.117	Z=2.857	t=2.265
P值		0.037	0.042	0.008	0.030
组别	术后血红蛋白下降值[g/L，M(Q)]	术后血肌酐[μmol/L，M(Q)]	术后收缩压[mmHg，(±s)]	术后舒张压[mmHg，(±s)]
非ICU组	9.07（0.49，17.65）	95.24（58.04，132.44）	110.55±16.58	68.24±11.86
ICU组	20.00（7.70，32.30）	178.71（36.61，320.82）	95.43±17.94	58.29±12.59
统计值	Z=2.653	Z=2.987	t=2.117	t=1.956
P值	0.013	0.007	0.042	0.059

组别	例数	术前中性粒细胞计数[×10⁹/L，(±s)]	术前中性粒细胞百分比[%，(±s)]	术前血肌酐[μmol/L，M(Q)]	术后血红蛋白[g/L，(±s)]
非ICU组	29	4.12±1.99	59.12±12.81	86.72（38.71，134.74）	108.00±16.87
ICU组	7	6.03±2.39	70.73±13.44	177.29（17.01，337.57）	91.29±19.52
统计值		t=2.178	t=2.117	Z=2.857	t=2.265
P值		0.037	0.042	0.008	0.030
组别	术后血红蛋白下降值[g/L，M(Q)]	术后血肌酐[μmol/L，M(Q)]	术后收缩压[mmHg，(±s)]	术后舒张压[mmHg，(±s)]
非ICU组	9.07（0.49，17.65）	95.24（58.04，132.44）	110.55±16.58	68.24±11.86
ICU组	20.00（7.70，32.30）	178.71（36.61，320.82）	95.43±17.94	58.29±12.59
统计值	Z=2.653	Z=2.987	t=2.117	t=1.956
P值	0.013	0.007	0.042	0.059

组别	例数	结石CT值[Hu，(±s)]	结石CT值>1 000 Hu [例(%)]	术后收缩压[mmHg，(±s)]	术后舒张压[mmHg，(±s)]
无休克组	13	905.69±302.91	4（30.77）	120.46±12.69	75.08±8.26
休克组	23	1 170.55±265.55	17（73.91）	100.35±15.99	61.35±11.80
统计值		t=2.733	χ²=6.361	t=3.888	t=3.702
P值		0.010	0.012	<0.001	<0.001
组别	脉搏[次/min，(±s)]	呼吸频率[次/min，(±s)]	休克指数(±s)	qSOFA [分，(±s)]	抗感染天数[d，(±s)]
无休克组	100.15±10.60	20.31±0.48	0.84±0.10	2.15±0.38	11.62±5.04
休克组	123.26±17.05	22.00±1.65	1.25±0.19	2.52±0.51	15.52±6.68
统计值	t=4.412	t=3.590	t=7.288	t=2.267	t=1.825
P值	<0.001	0.001	<0.001	0.030	0.076

组别	例数	结石CT值[Hu，(±s)]	结石CT值>1 000 Hu [例(%)]	术后收缩压[mmHg，(±s)]	术后舒张压[mmHg，(±s)]
无休克组	13	905.69±302.91	4（30.77）	120.46±12.69	75.08±8.26
休克组	23	1 170.55±265.55	17（73.91）	100.35±15.99	61.35±11.80
统计值		t=2.733	χ²=6.361	t=3.888	t=3.702
P值		0.010	0.012	<0.001	<0.001
组别	脉搏[次/min，(±s)]	呼吸频率[次/min，(±s)]	休克指数(±s)	qSOFA [分，(±s)]	抗感染天数[d，(±s)]
无休克组	100.15±10.60	20.31±0.48	0.84±0.10	2.15±0.38	11.62±5.04
休克组	123.26±17.05	22.00±1.65	1.25±0.19	2.52±0.51	15.52±6.68
统计值	t=4.412	t=3.590	t=7.288	t=2.267	t=1.825
P值	<0.001	0.001	<0.001	0.030	0.076

组别	例数	结石CT值[Hu，(±s)]	结石CT>1 000 Hu[例(%)]	术前中性粒细胞计数[×10⁹/L，(±s)]	术前中性粒细胞百分比[%，(±s)]	术后收缩压[mmHg，(±s)]	术后舒张压[mmHg，(±s)]
无休克组	12	906.48±317.68	4 (33.33)	5.07±2.42	65.78±14.26	121.50±12.66	75.75±8.25
休克组	17	1163.21±294.38	12 (70.59)	3.45±1.31	54.41±9.52	102.82±14.75	62.94±11.28
统计值		t=2.240	χ²=3.948	t=2.339	t=2.581	t=3.556	t=3.345
P值		0.034	0.047	0.027	0.016	0.001	0.002
组别	脉搏[次/min，(±s)]	呼吸频率[次/min，(±s)]	休克指数(±s)	qSOFA[分，(±s)]	亚胺培南/美罗培南使用[例(%)]	抗感染天数[d，(±s)]
无休克组	100.17±11.07	20.33±0.49	0.83±0.10	2.08±0.29	4（33.33）	10.92±4.56
休克组	127.00±16.34	22.35±1.58	1.25±0.21	2.53±0.51	11（64.71）	15.82±7.68
统计值	t=5.153	t=4.625	t=7.031	t=2.659	χ²=2.773	t=1.969
P值	<0.001	<0.001	<0.001	0.012	0.096	0.058

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