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J Urol. 2019 Aug;202(2):314-318. doi: 10.1097/JU.0000000000000195. Epub 2019 Jul 8.

Use of the Quick Sequential Organ Failure Assessment Score for Prediction of Intensive Care Unit Admission Due to Septic Shock after Percutaneous Nephrolithotomy: A Multicenter Study.

Author information

1
Departments of Urology, Massachusetts General Hospital , Boston , Massachusetts.
2
University of British Columbia , Vancouver , British Columbia , Canada.
3
Glickman Urological and Kidney Institute, Cleveland Clinic , Cleveland , Ohio.
4
Indiana University Health Physicians , Indianapolis , Indiana.
5
University of California-San Diego Health System , San Diego , California.
6
The Eye and Ear Institute , Columbus , Ohio.
7
Columbia University Medical Center , New York , New York.
8
Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville , Tennessee.
#
Contributed equally

Abstract

PURPOSE:

Recent studies have demonstrated that quick sequential organ failure assessment criteria may be more accurate than systemic inflammatory response syndrome criteria to predict postoperative sepsis. In this study we evaluated the ability of these 2 criteria to predict septic shock after percutaneous nephrolithotomy.

MATERIALS AND METHODS:

We performed a retrospective multicenter study in 320 patients who underwent percutaneous nephrolithotomy at a total of 8 institutions. The criteria for quick sequential organ failure assessment and systemic inflammatory response syndrome were collected 24 hours postoperatively. The study primary outcome was postoperative septic shock. Secondary outcomes included 30 and 90-day emergency department visits, and the hospital readmission rate.

RESULTS:

Three of the 320 patients (0.9%) met the criteria for postoperative septic shock. These 3 patients had positive criteria for quick sequential organ failure assessment and systemic inflammatory response syndrome. Of the entire cohort 23 patients (7%) met quick sequential organ failure assessment criteria and 103 (32%) met systemic inflammatory response syndrome criteria. Specificity for postoperative sepsis was significantly higher for quick sequential organ failure assessment than for systemic inflammatory response syndrome (93.3% vs 68.4%, McNemar test p <0.001). The positive predictive value was 13% for quick sequential organ failure assessment criteria and 2.9% for systemic inflammatory response syndrome criteria. On multivariate logistic regression systemic inflammatory response syndrome criteria significantly predicted an increased probability of the patient receiving a transfusion (β = 1.234, p <0.001). Positive quick sequential organ failure assessment criteria significantly predicted an increased probability of an emergency department visit within 30 days (β = 1.495, p <0.05), operative complications (β = 1.811, p <0.001) and transfusions (p <0.001). The main limitation of the study is that it was retrospective.

CONCLUSIONS:

Quick sequential organ failure assessment criteria were superior to systemic inflammatory response syndrome criteria to predict infectious complications after percutaneous nephrolithotomy.

KEYWORDS:

kidney; multiple organ failure; nephrolithotomy; percutaneous; sepsis; systemic inflammatory response syndrome

PMID:
30829131
DOI:
10.1097/JU.0000000000000195
[Indexed for MEDLINE]

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