Risk Factors For Fever And Sepsis After Percutaneous Nephrolithotomy: A Single-Center Study In Pakistan
DOI:
https://doi.org/10.69723/njms.05.01.0669Keywords:
Fever, Sepsis, PCNL (Percutaneous Nephrolithotomy), Risk Factors, PakistanAbstract
BACKGROUND: Percutaneous nephrolithotomy (PCNL) is a preferred treatment option for large and complex renal calculi. However, infectious complications such as postoperative fever and sepsis remain clinically significant. The pathogenesis is multifactorial, that involves patient, stone, and operative factors. Reported rates differ widely, and local data from Pakistan is limited. Identifying risk factors could improve perioperative management and reduces the morbidity.
OBJECTIVE: To determine the frequency of postoperative fever and sepsis after percutaneous nephrolithotomy (PCNL) and to identify associated preoperative and intraoperative risk factors.
METHODOLOGY: This study was conducted at the Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan, from January 15 to September 30, 2025. A total of 110 adult patients undergoing PCNL were enrolled. Data was collected and analysed using SPSS version 23. A p-value <0.05 was considered statistically significant.
RESULTS: The median age of the study participants was 38 years (IQR: 20), with 58.2% being male and 41.8% female. Postoperative fever (temperature ≥38°C within 7 days) occurred in 38 patients (34.5%), while sepsis defined according to SIRS criteria was observed in 6 patients (5.5%). On forward-stepwise multivariable analysis, staghorn calculi (aOR 8.95; 95% CI 1.64–48.88; p=0.011) and partial staghorn calculi (aOR 4.64; 95% CI 1.16–18.52; p=0.030) remained independent predictors of postoperative fever. Obesity was also associated with fever (aOR 44.4; 95% CI 1.70–1164; p=0.023); however, the wide confidence interval reflects imprecision due to small number of obese patients and should be interpreted cautiously. Longer operative time was significantly associated with both fever (p=0.034) and sepsis (p=0.002) on univariate analysis.
CONCLUSION: Staghorn and partial staghorn calculi were independent predictors of postoperative fever following PCNL. Although obesity showed statistical significance, the estimate lacked precision due to the small number of obese patients and should be interpreted cautiously. Prolonged operative time correlates with both fever and sepsis on univariate analysis. Recognizing risk factors allows clinicians to tailor perioperative care and enhance postoperative monitoring, and hence potentially reducing the complications.
References
1. Chewcharat A, Curhan G. Trends in the prevalence of kidney stones in the United States from 2007 to 2016. Urolithiasis. 2021;49(1):27-39. Doi:10.1007/s00240-020-01210-w
2. Knoll T, Daels F, Desai J, Hoznek A, Knudsen B, Montanari E, et al. Percutaneous nephrolithotomy: technique. World J Urol. 2017;35(9):1361-1368. Doi:10.1007/s00345-017-2001-0
3. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American Urological Association/Endourological Society guideline, Part I. J Urol. 2016;196(4):1153-60. Doi:10.1016/j.juro.2016.05.090
4. Taylor E, Miller J, Chi T, Stoller ML. Complications associated with percutaneous nephrolithotomy. Transl Androl Urol. 2012;1(4):223-228. Doi:10.3978/j.issn.2223-4683.2012.12.01
5. Falahatkar R, Falahatkar S, Khajavi Gaskarei MA, Afzalipoor M, Mojtahedi A, Aligolighasemabadi N, et al. The global prevalence and risk factors of postoperative fever after percutaneous nephrolithotomy: a systematic review and meta-analysis. Asian J Urol. 2024;11(2):253-260. Doi:10.1016/j.ajur.2022.04.008
6. Ward PA. Immunosuppression in sepsis. JAMA. 2011;306(23):2618-2619. Doi:10.1001/jama.2011.1831
7. Erridge C. Endogenous ligands of TLR2 and TLR4: agonists or assistants? J Leukoc Biol. 2010;87(6):989-999. Doi:10.1189/jlb.1209775
8. Liao MM, Lezotte D, Lowenstein SR, Howard K, Finley Z, Feng Z, et al. Sensitivity of systemic inflammatory response syndrome for critical illness among ED patients. Am J Emerg Med. 2014;32(11):1319-1325. Doi:10.1016/j.ajem.2014.07.035
9. Kaygısız O, Satar N, Güneş A, Doğan HS, Erözenci A, Özden E, et al. Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children. J Pediatr Urol. 2018;14(5):448.e1-448.e7. doi:10.1016/j.jpurol.2018.04.010
10. Zhou G, Zhou Y, Chen R, Wang D, Zhou S, Zhong J, et al. The influencing factors of infectious complications after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis. 2023;51(1):17. Doi:10.1007/s00240-022-01376-5
11. Gonzalez-Ramirez A, Camarena L, Gutierrez-Aceves J. 1544 risk factors for fever and sepsis after percutaneous nephrolithotomy. J Urol. 2013;189(4 Suppl):e633. Doi:10.1016/j.juro.2013.02.3034
12. Asghar M, Zafar MR, Kiani F, Mehmood A. Complications of percutaneous nephrolithotomy: single center experience of 103 cases. Pak Armed Forces Med J. 2016;66(2):270-274. Available from: https://pafmj.org/PAFMJ/article/view/577
13. Iqbal N, Hasan A, Malik HA, Khan R, Nazar A, Khawaja MA. A comparison of complications and success rates after PCNL in younger and elderly patients. J Coll Physicians Surg Pak. 2020;30(12):1316-1320. Doi:10.29271/jcpsp.2020.12.1316
14. Kumar GM, Nirmal KP, Kumar GS. Postoperative infective complications following percutaneous nephrolithotomy. Urol Ann. 2021;13(4):340-345. Doi:10.4103/UA.UA_153_20
15. De la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, Tefekli A; CROES PCNL Study Group. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25(1):11-17. Doi:10.1089/end.2010.0424
16. Rashid AO, Fakhralddin SS. Risk factors for fever and sepsis after percutaneous nephrolithotomy. Asian J Urol. 2016;3(2):82-87. Doi:10.1016/j.ajur.2016.03.001
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