Nutritional and Inflammatory Biomarkers Predict Postoperative Infectious Complications After Percutaneous Nephrolithotomy: A Retrospective Cohort Study.

BACKGROUND

Percutaneous nephrolithotomy (PCNL) is the primary surgical modality for managing renal calculi, yet the nonnegligible incidence of postoperative infectious complications significantly compromises patient prognosis.

OBJECTIVE

To develop a pre-operative predictive model based on nutritional and inflammatory biomarkers to quantify the risk of infectious complications following PCNL.

METHODS

From January 2022 to December 2024, 529 consecutive PCNL patients met the inclusion criteria. Pre-operative baseline characteristics, nutritional biomarkers (Prealbumin (PA), Hemoglobin (Hb), Prognostic Nutritional Index (PNI)), and inflammatory biomarkers (C-Reactive Protein (CRP), Procalcitonin (PCT), White Blood Cell Count (WBC), Neutrophil-to- Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII)) were collected. The main outcome was the occurrence of any infectious complication within 30 days. Univariable analysis screened candidate predictors; multivariable logistic regression integrated key biomarkers into a risk-prediction model. Receiver Operating Characteristic (ROC) curves were used to evaluate discrimination, providing the Area Under the Curve (AUC) and optimal cut-off values.

RESULTS

Among 529 patients who undergoing PCNL, 54 (10.21%) developed postoperative infectious complications. Multivariate logistic regression analysis identified four independent predictors: PNI (Odds Ratio (OR) = 0.386, p < 0.001), PLR (OR = 3.362, p = 0.009), NLR (OR = 2.446, p = 0.017), and SII (OR = 3.300, p < 0.001). The combined prediction model integrating these biomarkers demonstrated superior discriminative ability (AUC = 0.871, 95% Confidence Interval (CI): 0.839-0.898), significantly outperforming individual biomarkers (all p < 0.001).

CONCLUSIONS

A pre-operative model integrating nutritional and inflammatory biomarkers may accurately stratifies patients at high risk for infectious complications after PCNL, enabling early risk assessment and targeted intervention to improve outcomes.