Abstract：
Finding reliable and easy-to-obtain predictors of severe infectious complications after shock wave lithotripsy (SWL) is a major clinical need, particular in symptom-free hydronephrosis. Therefore, we aim to prospectively investigate the predictive value of Hounsfield units (HU) in renal pelvis urine for the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL. This multi-center prospective study was conducted from June 2020 to December 2023. The HU of renal pelvis urine was measured by non-enhanced computed tomography. The severe infectious complications included systemic inflammatory response syndrome, sepsis, and septic shock. Binary logistic regression models assessed the odds ratios (ORs) and 95% confidence intervals (CIs). Finally, 1,436 patients with ureteral stones were enrolled in this study. 8.9% (128/1,436) of patients experienced severe infectious complications after SWL treatment. After adjusting confounding variables, compared with the patients in the lowest renal pelvis urine density quartile, the OR (95% CI) for the highest quartile was 32.36 (13.32, 78.60). There was a positive linear association between the HU value of renal pelvis urine and the risk of severe infectious complications after SWL (P for trend < 0.001). Furthermore, this association was also observed stratified by age, gender, BMI, stone size, stone location and hydronephrosis grade (all P for interaction > 0.05). Additionally, the nonlinear association employed by restricted cubic splines is not statistically significant (nonlinear P = 0.256). The AUROC and 95%CI of renal pelvis urine density were 0.895 (0.862 to 0.927, P value < 0.001). The cut-off value was 12.0 HU with 78.59% sensitivity and 85.94% specificity. This multi-center prospective study demonstrated a positive linear association between HU in renal pelvis urine and the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL, regardless of age, gender, BMI, stone size, stone location, and hydronephrosis grade. These findings might be helpful in the SWL treatment decision-making process.
摘要：
寻找可靠且易于获得的冲击波碎石（SWL）后严重感染并发症的预测因子是主要的临床需求，特别是无症状肾积水。因此,我们旨在前瞻性研究肾盂尿中Hounsfield单位(HU)对输尿管结石和无症状肾积水患者SWL术后严重感染性并发症风险的预测价值.这项多中心前瞻性研究于2020年6月至2023年12月进行。通过非增强计算机断层扫描测量肾盂尿液的HU。严重的感染并发症包括全身炎症反应综合征,脓毒症,和感染性休克。二元逻辑回归模型评估了比值比(OR)和95%置信区间(CI)。最后,本研究纳入了1,436例输尿管结石患者。8.9%(128/1,436)的患者在SWL治疗后出现严重感染并发症。调整混杂变量后，与最低肾盂尿密度四分位数的患者相比，最高四分位数的OR（95％CI）为32.36（13.32，78.60）。肾盂尿HU值与SWL后严重感染并发症的风险呈正线性相关（P<0.001）。此外，这种关联也被观察到按年龄分层，性别,BMI,石头尺寸,结石位置和肾积水等级(交互作用均P>0.05)。此外,受限三次样条所采用的非线性关联在统计学上不显著(非线性P=0.256).肾盂尿密度AUROC和95CI分别为0.895(0.862～0.927,P值<0.001)。截断值为12.0HU，敏感性为78.59%，特异性为85.94%。这项多中心前瞻性研究表明，肾盂尿液中的HU与SWL后输尿管结石和无症状肾积水患者严重感染并发症的风险之间存在正线性相关。不管年龄,性别,BMI,石头尺寸,石头位置,和肾积水等级.这些发现可能有助于SWL治疗决策过程。
