Can preoperative neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predict systemic inflammatory response syndrome that develops after percutaneous nephrolithotomy?Uygar Miçooğulları1, Orcun celik1, Mehmet Çağlar Çakıcı2, Erdem Kisa1, Cem Yucel1, Okan Nabi Yalbuzdag1, Mehmet Yoldaş1, Hakan Üçok1, Tufan Süelözgen1, Mehmet Zeynel Keskin1, Yusuf Özlem İlbey1
1Department of Urology, University of Health Sciences, Tepecik Education and Research Hospital
2Department of Urology, Istanbul Medeniyet University, School of Medicine
Objective: The first aim of this study was to reveal factors affecting development of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PNL). Secondary objective was to determine the role of preoperative platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) in SIRS prediction.Keywords: neutrophil lymphocyte ratio, platelet-lymphocyte ratio, systemic inflammatory response syndrome, percutaneous nephrolithotomy, sepsis
Materials and Methods: The data of 756 patients that underwent PNL for kidney stones between 2012 and 2018 were evaluated retrospectively. Patients were divided into 2 groups as non-SIRS and SIRS group. The effects of PLR, NLR and other demographic and operative variables on development of SIRS were investigated. Multivariate logistic regression analysis that was performed on variables that were significant in the univariate analyses was used to establish independent risk factor for post-PNL SIRS.
Results: Univariate analysis revealed a significant association between presence of SIRS and preoperative PLR (p<0.001), preoperative NLR (p< 0.001), blood transfusion (p<0.001), stone volume (p=0.03), staghorn stone (p<0.001), and preoperative creatinine levels (<0.001). Multivariate logistic regression analyses of these risk factors showed that NLR (p<0.001), PLR (p<0.001), and blood transfusions (p<0.001) were independently associated with SIRS. When the PLR cut-off value was 120.5, the development of SIRS was predicted with 81% sensitivity and 80.1% specificity. When the NLR cut-off value was 2.75, the development of SIRS was predicted with 63.7% sensitivity and 64% specificity.
Conclusion: Preoperative PLR and NLR are effective and inexpensive biomarkers that can be used to predict SIRS and sepsis after PNL. We recommend that patients with PLR >120.5, NLR >2.75, and blood transfusions should be monitored closely due to the possible development of serious complications.
Corresponding Author: Uygar Miçooğulları, Türkiye