阅读说明：本技术 一种恒压灌注下mpcnl术后尿脓毒血症发生风险预测的评分方法 (Grading method for predicting risk of MPCNL postoperative uropyemia occurrence under constant pressure perfusion ) 是由 钟传华 晏恒馨 黄华 何志强 刘振 娄世洪 谭向金 田孟洪 于 2021-06-28 设计创作，主要内容包括：本申请公开了医疗技术领域中的一种恒压灌注下MPCNL术后尿脓毒血症发生风险预测的评分方法,包括以下步骤：S1、临床资料的收集：预先收集患者的临床资料,确定患者的纳入标准,确定病例组和对照组；S2、筛选术前因素；S3、用SPSS 25.0版本进行统计分析,通过单因素分析和按照逻辑评分法,构建恒压灌注下MPCNL术后尿脓毒血症危险评分系统；S4、在新患者手术前,根据发生风险预测的评分方法,计算此患者的危险评分,并在此患者手术前,医生根据患者的危险评分和危险分级进行干预。通过本发明对拟行恒压灌注下MPCNL的患者进行风险分层,筛选出术后发生尿脓毒血症的高危患者,从而实现尿脓毒血症个体化精准防治。(The application discloses a scoring method for predicting risk of urosepsis occurrence after MPCNL operation under constant pressure perfusion in the technical field of medical treatment, which comprises the following steps: s1, collection of clinical data: collecting clinical data of a patient in advance, determining an inclusion standard of the patient, and determining a case group and a control group; s2, screening preoperative factors; s3, carrying out statistical analysis by using the SPSS 25.0 version, and constructing a MPCNL postoperative urosepsis risk scoring system under constant pressure perfusion through single factor analysis and according to a logic scoring method; and S4, calculating the risk score of the patient according to the scoring method for risk prediction before the operation of the new patient, and performing intervention by a doctor according to the risk score and the risk score of the patient before the operation of the patient. The risk stratification is carried out on the patient who is proposed to be perfused with the MPCNL under the constant pressure through the invention, and the high-risk patient who has urosepsis after the operation is screened out, so that the individualized and accurate prevention and treatment of the urosepsis blood disease are realized.)

1. A scoring method for predicting the risk of occurrence of MPCNL postoperative uropyemia under constant pressure perfusion is characterized in that: the method comprises the following steps:

s1, collection of clinical data: collecting clinical data of MPCNL operation patients under constant pressure perfusion in advance, determining the inclusion standard of the patients, taking the patients with urosepsis as a case group after operation, grouping the patients according to the operation date of the patients of the case group, the same operator and the same operation time, and matching the patients with a control group according to the proportion;

s2, screening preoperative factors by combining literature data, wherein the preoperative factors comprise sex, age, diabetes, hypertension, the past urinary stone operation history, maximum stone diameter, multiple stones, cast stones, hydronephrosis, preoperative urinary leukocytes, urinary nitrite, preoperative blood routine and preoperative renal function;

s3, carrying out statistical analysis by using SPSS 25.0 version, carrying out Logistic regression analysis on indexes which are screened in single factor analysis and have statistical significance with the postoperative urosepsis, dividing independent risk factors of urosepsis in a multi-factor Logistic regression analysis result by a minimum regression coefficient by the corresponding regression coefficient according to a logic scoring method, rounding off an integer part to obtain risk scores corresponding to all the factors, and constructing an MPCNL postoperative urosepsis risk scoring system under constant pressure perfusion;

and S4, calculating the risk score of the patient according to the scoring method for risk prediction before the operation of the new patient, and performing intervention by a doctor according to the risk score and the risk score of the patient before the operation of the patient.

2. The scoring method for predicting the risk of developing urosepsis under MPCNL surgery under constant pressure perfusion according to claim 1, wherein: the inclusion criteria for the patients were: firstly, the diagnosis is confirmed by B-ultrasonic, venous urography or non-enhanced CT scanning imaging examination, and the PCNL operation indication is met; displaying constant pressure perfusion in the operation: the pressure of the perfusion pressure pump is constant at 200mmHg, and the perfusion flow rate is 0.2L/min; and the perfusion amount in the operation is not more than 10L.

3. The scoring method for predicting the risk of developing urosepsis under MPCNL surgery under constant pressure perfusion according to claim 2, wherein: criteria for patient exclusion: firstly, cases of sepsis caused by infection of other systems after operation; ② patients who are only used after percutaneous nephroscope fistulation and have sepsis.

4. The scoring method for predicting the risk of developing urosepsis under constant pressure perfusion MPCNL after operation according to any one of claims 1-3, wherein: the ratio of the number of patients in the case group to the number of patients in the control group is not less than 1: 5.

5. The scoring method for predicting the risk of developing urosepsis under MPCNL surgery under constant pressure perfusion according to claim 4, wherein: the same operation time is divided into more than or equal to 90min and less than 90 min.

6. The scoring method for predicting the risk of developing urosepsis under MPCNL surgery under constant pressure perfusion according to claim 5, wherein: the independent risk factors comprise that the urine leucocyte is more than or equal to 2 percent, the urine nitrite is positive, and the ratio of the neutrophil to the lymphocyte is more than or equal to 2.5.

7. The scoring method for predicting the risk of developing urosepsis under MPCNL surgery under constant pressure perfusion according to claim 6, wherein: and step S3, a scoring system is verified, the degree of discrimination of the scoring system is evaluated by using an ROC curve and the degree of calibration of the scoring system is evaluated by using a Hosmer-Lemeshow goodness-of-fit test, and 50% of cases are randomly extracted from modeling samples to be internally verified in a verification group sample line.

8. The scoring method for predicting the risk of developing urosepsis under MPCNL surgery under constant pressure perfusion according to claim 7, wherein: the score of more than or equal to 2 is predicted to be a high risk group of MPCNL patients who have urosepsis blood diseases under constant pressure perfusion.

9. A scoring system for predicting risk of MPCNL postoperative urosepsis occurrence under constant pressure perfusion is established according to the method of any one of claims 5-7.

Technical Field

The invention relates to the technical field of medical treatment, in particular to a scoring method for predicting risk of urosepsis after MPCNL operation under constant pressure perfusion.

Background

Urosepsis is a serious complication of microchannel percutaneous nephrolithotomy (MPCNL), has a high mortality rate, and with continuous innovation of MPCNL surgical techniques and continuous deepening of understanding of postoperative urosepsis, clinical importance is attached to control of risk factors such as operation time, perfusion pressure and perfusion volume in MPCNL surgery, and MPCNL surgery under constant pressure perfusion for controlling factors in surgery is widely applied to clinical practice. In recent years, research on risk factors of MPCNL postoperative urosepsis blood diseases is more, but how to establish a risk prediction scoring system of MPCNL postoperative urosepsis blood diseases under constant-pressure perfusion by using preoperative risk factors is rarely reported at home and abroad.

Disclosure of Invention

Aiming at the defects of the prior art, the invention provides a scoring method for evaluating the risk degree of the urinary sepsis of a patient after the operation so as to early warn.

One of the purposes of the invention is to provide a scoring method for predicting the risk of urosepsis occurrence after MPCNL operation under constant pressure perfusion, which comprises the following steps:

s1, collection of clinical data: collecting clinical data of MPCNL operation patients under constant pressure perfusion in advance, determining the inclusion standard of the patients, taking the patients with urosepsis as a case group after operation, grouping the patients according to the operation date of the patients of the case group, the same operator and the same operation time, and matching the patients with a control group according to the proportion;

s2, screening preoperative factors by combining literature data, wherein the preoperative factors comprise sex, age, diabetes, hypertension, the past urinary stone operation history, maximum stone diameter, multiple stones, cast stones, hydronephrosis, preoperative urinary leukocytes, urinary nitrite, preoperative blood routine and preoperative renal function;

s3, carrying out statistical analysis by using SPSS 25.0 version, carrying out Logistic regression analysis on indexes which are screened in single factor analysis and have statistical significance with the urosepsis after the operation, dividing independent risk factors of urosepsis in a multi-factor Logistic regression analysis result by a minimum regression coefficient by using corresponding regression coefficients according to a logic scoring method, rounding off an integer part to obtain risk scores corresponding to all the factors, modeling, and constructing a MPCNL postoperative urosepsis risk scoring system under constant pressure perfusion;

and S4, calculating the risk score of the patient according to the scoring method for risk prediction before the operation of the new patient, and performing intervention by a doctor according to the risk score and the risk score of the patient before the operation of the patient.

Further, the patient inclusion criteria were: firstly, the diagnosis is confirmed by B-ultrasonic, venous urography or non-enhanced CT scanning imaging examination, and the PCNL operation indication is met; displaying constant pressure perfusion in the operation: the pressure of the perfusion pressure pump is constant at 200mmHg, and the perfusion flow rate is 0.2L/min; and the perfusion amount in the operation is not more than 10L.

Further, criteria for patient exclusion: firstly, cases of sepsis caused by infection of other systems after operation; ② patients who are only used after percutaneous nephroscope fistulation and have sepsis.

Further, the ratio of the number of patients in the case group to the number of patients in the control group is not less than 1: 5. The larger the ratio, the greater the number of patients in the control group matched accordingly, and the preferred ratio of the present invention is 1: 5.

Furthermore, the same operation duration is divided into more than or equal to 90min and less than 90 min. According to research reports, the operation time is limited by 90min, the operation time is longer than (or equal to) 90min, the postoperative probability of urosepsis is longer than the operation time and is shorter than 90min, so when the control group is matched, the operation time is used as one of the standards for screening the control group.

Furthermore, the independent risk factors comprise that the urine leucocyte is more than or equal to 2 percent, the urine nitrite is positive, and the ratio of the neutrophil to the lymphocyte is more than or equal to 2.5 for women.

Further, step S3 is to verify the system after constructing the scoring system, evaluate the calibration degree of the scoring system by using the ROC curve to evaluate the discrimination of the scoring system and the Hosmer-Lemeshow goodness-of-fit test, and randomly extract 50% of cases from the modeling samples as the verification group sample line internal verification.

Further, the score is more than or equal to 2, and the prediction is that the MPCNL patient is a high risk group of urosepsis under constant pressure perfusion.

The invention also aims to provide a scoring system for predicting the risk of urosepsis occurrence after the MPCNL operation under constant pressure perfusion, which comprises the following steps: s1, collection of clinical data: collecting clinical data of MPCNL operation patients under constant pressure perfusion in advance, determining the inclusion standard of the patients, taking the patients with urosepsis as a case group after operation, grouping the patients according to the operation date of the patients of the case group, the same operator and the same operation time, and matching the patients with a control group according to the proportion;

s2, screening preoperative factors including gender, age, diabetes, hypertension, past urinary stone operation history, maximum stone diameter, multiple stones, cast stones, hydronephrosis, preoperative urinary leukocytes, urinary nitrite, preoperative, blood leukocyte count, platelet count, neutrophil to lymphocyte ratio, preoperative urea nitrogen, creatinine;

s3, carrying out statistical analysis by using SPSS 25.0 version, carrying out Logistic regression analysis on indexes which are screened in single factor analysis and have statistical significance with the postoperative urosepsis, dividing the independent risk factors of urosepsis in the multi-factor Logistic regression analysis result by the corresponding regression coefficients by the minimum regression coefficients according to a logic scoring method, rounding off the integral part to obtain the risk scores corresponding to all the factors, and constructing the MPCNL postoperative urosepsis risk scoring system under constant pressure perfusion.

The working principle and the beneficial effects of the invention are as follows: the research adopts a nested case contrast research method, patients who have urosepsis after MPCNL operation under constant pressure perfusion are taken as a case group, the same operator (doctor who performs operation), the close operation date (operation date +/-3 months), the same operation duration (more than or equal to 90 minutes group and less than 90 minutes group) are grouped, the case group is matched with a contrast group, for example, the operation time of 1 patient in the case group is 100 minutes, and when the contrast group is matched, 5 patients of the same operator are screened from the group which is3 months before and after the operation time (preferably the patient closest to the operation date of the case group) and the operation time is more than or equal to 90 minutes, and are matched with the case group. Under the premise of strictly controlling the influence of factors in operation such as operators, operation date, operation duration, perfusion pressure and the like, the prediction effect of factors before the operation on the occurrence of postoperative uropyemia is researched, a quantitative evaluation system for the occurrence risk of the MPCNL postoperative uropyemia under constant pressure perfusion is established, risk stratification is carried out on patients who are subjected to MPCNL, high-risk patients who have uropyemia after the operation are screened out, and therefore the individualized and accurate prevention and treatment of uropyemia are achieved.

The study suggests that women, urine WBC ≥ 2+, urine NIT positivity and NLR ≥ 2.5 are independent risk factors for MPCNL patients under constant pressure perfusion to suffer from urosepsis. Of the 4 independent risk factors, NLR is less discussed in the literature. NLR is the ratio of the peripheral blood neutrophils to the lymphocytes of the organism, is a simple and effective index for predicting the severity of infection, and is superior to the total number of leucocytes, the neutrophil count and C-reactive protein. According to the study, 2.5 is taken as a cutoff value of NLR, and analysis shows that the risk of urosepsis after the operation of a patient with the NLR more than or equal to 2.5 before the operation is 4.302 times that of a patient with the NLR less than 2.5 (95% CI: 1.458-12.692, P ═ 0.008), which indicates that the NLR before the operation is closely related to the occurrence of urosepsis after the operation.

The research initially constructs a WaN-2 scoring system which predicts the urosepsis of the MPCNL patient under constant pressure perfusion to have 0.831[ 95% CI (0.740-0.921) and P ═ 0.000], and the predicting efficiency of the scoring system still reaches 0.826[ 95% CI (0.712-0.941) and P ═ 0.000] after internal verification, and the difference between the model prediction value and the actual observation value is found to have no statistical significance (P is more than 0.05) by the Hosmer-Lemshow goodness-fit test of a modeling group and a verification group, which indicates that the WaN-2 scoring system has good discrimination and calibration. Meanwhile, the indexes such as gender, urine WBC, urine NIT and NLR are simple indexes which can be rapidly acquired in clinic, and the feasibility of the scoring system in clinical application is greatly improved.

The research result shows that when the WaN-2 score is more than or equal to 2, the risk of the occurrence of the sepsis after the operation is obviously increased, according to the score of each factor, the condition can be met when the NIT of the urine before the operation is positive, and at least 2 other risk factors can be met when the NIT is not positive, so that the clinical work is guided clearly, the prior urine NIT positive patient and the female patient with WBC more than or equal to 2+ or (and) NLR more than or equal to 2.5 are more careful, the clinician gives enough attention in the communication process with the patients and family members, enough prevention consciousness and postoperative emergency treatment measures are required in the perioperative period, and the occurrence risk of the sepsis can be reduced by carrying out fractional calculus so as to reduce the operation time.

Drawings

FIG. 1 is a graph of risk score-probability curve in a scoring system for predicting risk of developing MPCNL postoperative urosepsis under constant pressure perfusion;

in FIG. 2, A is a modeling group ROC curve and B is a validation group ROC curve.

Detailed Description

The following is further detailed by way of specific embodiments:

1 materials and methods

1.1 case data retrospective nested case control study approach was used: 422 patients of MPCNL operation under constant pressure perfusion in urological surgery of people hospitals in Guangzhou city sowing district at 12 months 12-2020 at 2018 are selected as a cohort group, 26 patients with urosepsis blood disease after operation are taken as a case group, the MPCNL operation under constant pressure perfusion which is the closest to the same operator at the time point is searched through the operation date of the case group, and the MPCNL operation is divided into groups according to the same operation time (more than or equal to 90min or less than 90min) according to the proportion of 1: the ratio of 5 matched 130 cases of the contemporary control group. The information of the case data incorporated into the study was collected, recorded, and summarized by 3 urologists via the hospital electronic case database. Patient inclusion criteria were: firstly, the diagnosis is confirmed through the imaging examination such as B-ultrasound, venous urography or non-enhanced CT scanning and the like, and the indications of the PCNL operation are met according to the 2014 Chinese urinary surgery disease diagnosis and treatment guideline; ② constant pressure perfusion (the pressure of a perfusion pressure pump is constant at 200mmHg, the perfusion flow rate is 0.2L/min) in the operation; the perfusion amount in the operation is not more than 10L; obtaining patient consent before examination and treatment and signing consent. Patient exclusion criteria were: firstly, cases of sepsis caused by infection of other systems after operation; ② patients who are only used after percutaneous nephroscope fistulation and have sepsis. Sepsis diagnosis was according to sepsis3.0 diagnostic criteria.

1.2 grouping evaluation index: the number of Events (EPV) required for the mean independent variable in this study was > 5. Finally screening the following preoperative factors by combining domestic and foreign documents: general condition of the patient (sex, age, diabetes, hypertension, past urinary stone surgery history), maximum stone diameter, multiple stones, cast stones, hydronephrosis (moderate-grade), pre-operative urine routine (white blood cells, WBC), urine nitrite (nitrite, NIT)), pre-operative blood routine (blood leukocyte count, platelet count, neutrophil to lymphocyte ratio (NLR)), pre-operative renal function (urea nitrogen, creatinine).

1.3 statistical analysis: statistical analysis was performed using SPSS version 25.0. And evaluating whether the measurement data are subjected to normal distribution by adopting a normal P-P diagram. Normally distributed measurement data are expressed in (x +/-s), and independent sample t test is adopted for comparison among groups; the skewed distribution of the measured data is expressed as M (Q1, Q3) and the Mann-Whitney U test is used for comparison between groups. Counting data rate or composition ratio, and comparing between groups by χ²And (6) checking. The method comprises the steps of bringing variables with statistical significance in single factor analysis into multi-factor Logistic regression analysis, dividing independent risk factors of urosepsis in multi-factor Logistic regression analysis results by corresponding regression coefficients by minimum regression coefficients according to a logic scoring method of SULLIVAN and the like, rounding off an integer part, and obtaining risk corresponding to each factorAnd (4) scoring, modeling, and constructing a MPCNL postoperative urosepsis risk scoring system under constant-pressure perfusion. The internal verification of the row of verification group samples was randomly drawn from the modeling group samples for 50% of the cases (78 cases). The risk scoring system adopts two indexes of discrimination and calibration. The discrimination of a test subject operator characteristic (ROC) curve verification scoring system is utilized, the calibration degree of the verification scoring system is tested by means of the Housmer-Lemeshow goodness of fit, and the high risk group is determined according to the ROC curve optimal critical value. P < 0.05 is statistically significant.

2 results

2.1 Single-factor analysis of post-operative urosepsis:

in the observed indexes, the single-factor analysis result shows that the female, the urinary calculus operation history, hydronephrosis (moderate-severe), urine WBC (not less than 2+), urine NIT positive and NLR (not less than 2.5) are related to the occurrence of urosepsis blood disease after the MPCNL operation under constant pressure perfusion (P is less than 0.05, Table 1).

TABLE 1 analysis of risk factors for urosepsis after constant pressure perfusion of descending MPCNL

2.2 multifactorial analysis of post-operative urosepsis:

6 indexes which are screened from the single-factor analysis and have statistical significance with the postoperative urosepsis are subjected to Logistic regression analysis. The results show that women (β ═ 1.146, P ═ 0.030), urine WBC ≥ 2+ (β ═ 1.088, P ═ 0.047), urine NIT positive (β ═ 2.653, P ═ 0.000), NLR ≥ 2.5(β ═ 1.459, P ═ 0.008) are independent risk factors for urosepsis after surgery in MPCNL patients under constant pressure perfusion (table 2). The Variance Inflation Factors (VIF) for the 4 risk factor co-linearity diagnosis were 1.060, 1.091, 1.093, and 1.009, respectively, suggesting that there is no multiple co-linearity for the 4 risk factors.

TABLE 2 Multi-factor Logistic regression analysis of post-operative urosepsis with constant pressure perfusion of descending MPCNL

2.3 establishment of a Risk scoring System:

and dividing the independent risk factors of the urosepsis blood disease in the multi-factor Logistic regression analysis result by the corresponding regression coefficients by the minimum regression coefficients, and rounding off the integral part to obtain the risk score corresponding to each factor. The total risk score of the scoring system is 5 points, wherein the female is 1 point, urine WBC is more than or equal to 2+ is 1 point, NLR is more than or equal to 2.5 is 1 point, urine NIT positive is 2 points, and the scoring system is named as WaN-2 score (Table 3).

TABLE 3WaN-2 Scoring Table

2.4 establishing a risk score-probability table and a curve:

referring to an edit scoring method, the original Logistic regression model is simplified into a new danger scoring model with only one independent variable through mathematical transformation:wherein S_cTotal risk score. According to the risk score model, a prediction probability distribution table (table 4) of each risk score is calculated, and a P prediction-Sc graph (fig. 1) is drawn. As can be seen from table 4 and fig. 1: when the risk score of the WaN-2 score is increased from 0 to 5, the predicted prevalence rate is also increased from 2.63% to 86.15%, and the total rate is increased. The higher the WaN-2 score, the higher the likelihood of post-operative urosepsis in MPCNL patients under constant pressure perfusion.

TABLE 4WaN-2 prediction probability distribution table for each risk score of scoring system

2.5 verification and risk grading utilization of the scoring system:

the ROC curve evaluates WaN-2 the discrimination of the scoring system, and the Hosmer-Lemeshow goodness-of-fit test evaluates the calibration of the scoring system. The internal verification of the row of verification group samples was randomly drawn from the modeling group samples for 50% of the cases (78 cases). The results show that the area under the ROC curve of the modeling group is 0.831[ 95% CI (0.740-0.921), P ═ 0.000 ]; the area under the validation set ROC curve is 0.826[ 95% C (I0.712-0.941) P is 0.000], see fig. 2. The fitting goodness test of the building module Hosmer-Lemshow shows that the difference between the predicted value and the actual observed value of the model has no statistical difference (x 2 is 1.124, and P is 0.771); the validation set Hosmer-Lemshow goodness-of-fit test showed no statistical difference in the difference between the model predicted values and the actual observed values (χ 2 ═ 0.884, P ═ 0.643). The discrimination and calibration verification shows that the scoring system has strong prediction capability. When the WaN-2 score was 1.5, the Yoden index was maximal, at which time the sensitivity was 73.1% and the specificity was 78.5%, so patients with a score of WaN-2 of 2 or more were assigned to the high risk group of urosepsis patients under constant pressure perfusion in MPCNL.

When the WaN-2 score is more than or equal to 2, the clinician pays enough attention in the communication process with the patients and family members, has enough prevention consciousness and postoperative emergency treatment measures in the perioperative period, and can reduce the occurrence risk of the sepsis by breaking the stones in times so as to reduce the operative time.

The foregoing is merely an example of the present invention and common general knowledge of known specific structures and features of the embodiments is not described herein in any greater detail. It should be noted that, for those skilled in the art, without departing from the structure of the present invention, several changes and modifications can be made, which should also be regarded as the protection scope of the present invention, and these will not affect the effect of the implementation of the present invention and the practicability of the patent. The scope of the claims of the present application shall be determined by the contents of the claims, and the description of the embodiments and the like in the specification shall be used to explain the contents of the claims.