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Risk of Systemic Inflammatory Response Syndrome Following Preoperative Glucocorticoids Administration in Patients After Percutaneous Nephrolithotomy: A Retrospective Cohort Study

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Abstract

Introduction

Systemic inflammatory response syndrome (SIRS) is one of the most serious complications in patients undergoing percutaneous nephrolithotomy (PCNL). Although glucocorticoids are increasingly used during PCNL, few studies have been concerned about the association between glucocorticoids and postoperative SIRS. The study aims to explore whether preoperative use of glucocorticoids is associated with SIRS after PCNL.

Methods

A total of 1259 patients who underwent PCNL between January 2015 and April 2021 were enrolled in the retrospective cohort study. Risk factors for post-PCNL SIRS were identified by univariate and multivariate regression analysis. To further explore the association between preoperative administration of glucocorticoids and SIRS, 113 pairs of patients were matched for the confounding factors using propensity score matching (PSM) analysis. The odds ratios (OR) and 95 % confidence intervals (CI) for the above variables were analyzed.

Results

The incidence of SIRS after PCNL was 9.6 % (121/1259) and the patients who suffered from postoperative SIRS had longer hospital stays and higher hospital costs (all p < 0.05). Multivariate logistic regression analysis indicated that female, preoperative leukocyte count, insertion of central vein catheter, serum albumin, preoperative high-sensitive C-reactive protein/albumin ratio, preoperative transfusion, preoperative administration of glucocorticoids were independent risk factors for SIRS (all p < 0.05). After minimization, the effects of confounding factors by PSM, preoperative administration of glucocorticoids was significantly correlated with SIRS in patients after PCNL (OR=2.44, 95 %CI: 1.31–4.55, p = 0.005).

Conclusion

Preoperative administration of glucocorticoids is an independent risk factor for SIRS in patients undergoing PCNL.

Plain Language Summary

Systemic inflammatory response syndrome (SIRS) is a frequent and severe complication in patients underwent percutaneous nephrolithotomy (PCNL), which can be challenging to diagnose early, potentially leading to delayed treatment. Identifying SIRS risk factors and promptly treating high-risk patients is crucial. Glucocorticoids are commonly used to prevent SIRS in clinical practice, and this study aims to investigate whether preoperative glucocorticoid administration is associated with SIRS after PCNL. In total, 1259 patients underwent PCNL and were enrolled in the study. The study utilized both propensity score matching (PSM) analysis and regression analysis to identify risk factors for post-PCNL SIRS. The incidence of SIRS after PCNL was 9.6 % in the study and patients with postoperative SIRS had longer hospital stays and higher hospital costs. After minimizing the potential influence of confounding factors through the use of PSM, we found a significant association between the preoperative use of glucocorticoids and the occurrence of SIRS in patients undergoing PCNL. Based on our analysis, we can conclude that the preoperative administration of glucocorticoids represents an independent risk factor for the development of SIRS in these patients.

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Author notes

  1. Jingping Hu, Chaojin Chen and Xiaoyue Li contributed equally to the work and all share first authorship.

Authors and Affiliations

  1. Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China

    Jingping Hu, Chaojin Chen, Xiaoyue Li, Xiangyang Zang, Shaoli Zhou & Chulian Gong

  2. Guangzhou AID Cloud Technology Co., Ltd, Guangzhou, 510000, China

    Jie Ke

  3. Department of Pharmacy, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, Guangdong, China

    Haiyan Mai

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  1. Jingping Hu
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Corresponding authors

Correspondence to Shaoli Zhou, Haiyan Mai or Chulian Gong.

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Funding

This study was supported partly by the National Natural Science Foundation of China (Grant No. 82102297), Natural Science Foundation of Guangdong Province (Grant No. 2022A1515012603), Young Talent Support Project of Guangzhou Association for Science and Technology (Grant No. QT20220101257), the “Five and five” Project of the Third Affiliated Hospital of Sun Yat-Sen University (grant No. 2023WW501) and Science and Technology Planning Project of Guangdong Province-Regional Innovation Capacity and Support System Construction (grant No. 2023B110006).

Conflict of interest

Not applicable.

Ethics approval

This study was conducted in accordance with the Declaration of Helsinki and the protocol and it was approved by the Ethics Committee of our hospital on 14 May 2019 (No. [2019]02–609-02). The requirement for informed consent and clinical trial registration were waived by the committee.

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Availability of data and material

The data and material are available from the corresponding author on reasonable request.

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Author contributions

JPH: data collection, data analysis and write-up of manuscript. CJC and XYL: data collection, data analysis and interpretation. JK: study design, data analysis, and interpretation. XYZ: data collection and critical review of manuscript. SLZ, HYM and CLG: study conception, study design, data analysis and interpretation and critical review of manuscript. All authors read and approved the final version of this manuscript.

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Hu, J., Chen, C., Li, X. et al. Risk of Systemic Inflammatory Response Syndrome Following Preoperative Glucocorticoids Administration in Patients After Percutaneous Nephrolithotomy: A Retrospective Cohort Study. Drug Saf 47, 465–474 (2024). https://doi.org/10.1007/s40264-024-01402-y

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