Diagnostic Clinical Predictors of Early Recovery from Stone-Induced Systemic Inflammatory Response Syndrome After Urgent Decompression.

Background

To identify clinical predictors of early recovery in patients with stone-induced systemic inflammatory response syndrome (SIRS) undergoing emergency decompression and compare the short-term inflammatory and renal function outcomes between retrograde ureteral stenting (RUS) and percutaneous nephrostomy (PCN). Method: We retrospectively evaluated data from 178 patients with stone-induced SIRS who were treated with RUS (n = 98) or PCN (n = 80) between 2011 and 2020. Early recovery was defined as readiness for discharge or no fever relapse within 3 days after drainage.

Results

Univariate and multivariate logistic regression analyses identified significant predictors, and clinical outcomes were compared based on drainage methods. Univariate analysis showed that diabetes mellitus (p = 0.009), mid (p = 0.014) and upper (p = 0.017) stone locations, stone size of 10-20 mm, and renal stones were associated with early recovery, whereas female sex (p = 0.01) predicted poorer outcomes. In multivariate analysis, diabetes mellitus (p = 0.031), as well as mid (p = 0.007) and upper (p = 0.026) stone locations, remained favorable predictors, and female sex (p = 0.036) remained a negative predictor. PCN was associated with a transient increase in leukocyte count but facilitated earlier creatinine recovery compared with RUS.

Conclusions

Female sex was an independent predictor of failure to achieve early recovery after urgent decompression, whereas diabetes mellitus and proximal ureteral stone location were independent predictors of early recovery. Baseline clinical factors were the main determinants of early recovery, supporting management tailored to these factors.