PDF(Pubmed)
Abstract：
The risk factors of complications after SWL are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting major complications after extracorporeal shockwave lithotripsy (SWL) in patients with ureteral stones. The development cohort included 1522 patients with ureteral stones who underwent SWL between June 2020 and August 2021 in our hospital. Five hundred and fifty-three patients with ureteral stones participated in the validation cohort from September 2020 to April 2022. The data were prospectively recorded. Backward stepwise selection was applied using the likelihood ratio test with Akaike\'s information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 7.2% (110/1522) of patients in the development cohort and 8.7% (48/553) of those in the validation cohort suffered from major complications. We identified five predictive factors for major complications: age, gender, stone size, Hounsfield unit of stone, and hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic curves of 0.885 (0.872-0.940) and good calibration (P = 0.139). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that older age, female gender, higher Hounsfield unit, size, and grade of hydronephrosis were risk predictors of major complications after SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of high-risk patients may decrease postoperative morbidity.
摘要：
SWL术后并发症的危险因素尚未明确。因此,基于一个庞大的前瞻性队列，我们的目的是建立并验证用于预测输尿管结石患者体外冲击波碎石(SWL)术后主要并发症的列线图.发展队列包括2020年6月至2021年8月在我院接受SWL的1522例输尿管结石患者。从2020年9月至2022年4月，有550例输尿管结石患者参加了验证队列。数据是前瞻性记录的。以Akaike的信息准则为停止规则，使用似然比检验应用向后逐步选择。评估了该预测模型的临床有效性，校准,和歧视。最后,发展队列中7.2％（110/1522）的患者和验证队列中8.7％（48/553）的患者患有严重并发症。我们确定了主要并发症的五个预测因素：年龄，性别,石头尺寸,Hounsfield单位的石头，和肾积水.该模型显示出良好的区分性，接收器工作特性曲线下的面积为0.885（0.872-0.940），校准良好（P=0.139）。决策曲线分析表明该模型具有临床应用价值。在这个庞大的前瞻性队列中，我们发现年纪大了，女性性别,更高的Hounsfield单位，尺寸,和肾积水等级是SWL术后主要并发症的风险预测因子。此列线图将有助于术前风险分层，为每位患者提供个性化的治疗建议。此外，对高危患者的早期识别和适当管理可降低术后发病率.
