Retrograd intrarenal cerrahi (RIRS) sonrası sistemik inflamatuar yanıt sendromu (SIRS) için preoperatif sistemik immün-inflamasyon (SII) indeksi ve hematolojik inflamatuar parametreler öngörücü müdür

Yıl 2025, Cilt: 20 Sayı: 2, 79 - 88, 29.06.2025

Tugay Aksakalli , Ahmet Cinislioğlu , Şaban Oğuz Demirdöğen , Adem Utlu , Fatih Akkaş , İbrahim Karabulut

https://doi.org/10.33719/nju1635892

Öz

Böbrek taşı nedeniyle retrograd intrarenal cerrahi (RIRS) uygulanan hastalarda ameliyat öncesi trombosit lenfosit oranı (PLR), nötrofil lenfosit oranı (NLR) ve sistemik immün inflamasyon (SII) indeksi değerleri ile sistemik inflamatuvar yanıt sendromu (SIRS) gelişimi arasında ilişki olup olmadığını değerlendirmek amaçlanmıştır. RIRS uygulanan hastaların demografik ve laboratuvar verileri toplandı. Tam kan sayımı parametrelerinden NLR, PLR ve SII indeksi elde edildi. Taş özellikleri ameliyat öncesi kontrastsız bilgisayarlı tomografi ile elde edildi. Ameliyat süresi üreter erişim kılıfının yerleştirilmesinden DJ stent yerleştirilmesine kadar geçen süre olarak belirlendi. Çalışmaya dahil edilen 748 hastanın 27’sinde (%3,6) SIRS saptandı. Taş hacmi, Hb düzeyi, ameliyat süresi ve SII indeksi SIRS’i öngörmede bağımsız risk faktörleriydi. Taş hacmine bağlı olarak SIRS'yi tahmin etmek için belirlenen eşik 1589 mm³ olup, %88,9 duyarlılık, %70,0 özgüllük ve 0,863 eğri altında kalan alan (AUC) göstermektedir. Hemoglobin seviyesi kesme değeri 14,9 g/dl olup, %96,3 duyarlılık, %56,0 özgüllük ve 0,198 AUC'dir. SII indeksi eşiği 703 olup, %81,5 duyarlılık, %73,5 özgüllük ve 0,820 AUC sağlamaktadır. Ameliyat süresi kesme değeri 62,5 dakika olup, %88,3 duyarlılık, %93,3 özgüllük ve 0,967 AUC göstermektedir. SII indeksi, RIRS'yi takiben SIRS için bağımsız, kolay erişilebilir ve uygun maliyetli bir öngörücü gibi görünmektedir.

Anahtar Kelimeler

Renal taş , Retrograt intrarenal cerrahi , SII indeks , SIRS

Are the Preoperative Systemic Immune-Inflammation (SII) Index and Hematological Inflammatory Parameters Predictors for Systemic Inflammatory Response Syndrome (SIRS) After Retrograde Intrarenal Surgery (RIRS)?

Öz

Objective: The study aimed to evaluate whether there is a relationship between the preoperative values of the platelet lymphocyte ratio (PLR), the neutrophil lymphocyte ratio (NLR), and systemic immune inflammation (SII) index and the development of systemic inflammatory response syndrome (SIRS) in patients undergoing retrograde intrarenal surgery (RIRS) for kidney stones.
Material and Methods: Demographic and laboratory data of patients who underwent RIRS were collected. NLR, PLR, and SII indices were obtained from the complete blood count parameters. Stone characteristics were obtained from preoperative non-contrast computed tomography. Univariate and multivariate analyses were performed to identify risk factors of SIRS.
Results: SIRS was detected in 27 (3.6%) of 748 patients included in the study. Stone volume, Hb level, operation time, and SII index were independent risk factors in predicting SIRS. The established threshold for predicting SIRS based on stone volume is 1589 mm³, demonstrating a sensitivity of 88.9%, specificity of 70.0%, and an area under the curve (AUC) of 0.863. The hemoglobin level cut-off is 14.9 g/dl, with a sensitivity of 96.3%, specificity of 56.0%, and AUC of 0.198. The SII index threshold is 703, yielding a sensitivity of 81.5%, specificity of 73.5%, and AUC of 0.820. The operation time cut-off is 62.5 minutes, showing a sensitivity of 88.3%, specificity of 93.3%, and AUC of 0.967.
Conclusion: The SII index appears to be an independent, easily accessible, and cost-effective predictor for SIRS following RIRS.

Anahtar Kelimeler

Renal stone , Retrograde Intrarenal Surgery , SII index , SIRS

Etik Beyan

This study was approved by the Ataturk University Local Ethics Committee 30.03.2023 (approval number: B.30.2.ATA.0.01.00/235).

Destekleyen Kurum

None.

Kaynakça

• 1. Zeng G, Traxer O, Zhong W, et al. International Alliance of Urolithiasis guideline on retrograde intrarenal surgery. BJU international. 2023;131(2):153-164. https://doi.org/10.1111/bju.15836
• 2. Sari S, Ozok HU, Cakici MC, et al. A Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy for Management of Renal Stones? 2 CM. Urol J. 2017;14(1):2949-2954.
• 3. Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475-482. https://doi.org/10.1016/j.eururo.2015.07.041
• 4. Grosso AA, Sessa F, Campi R, et al. Intraoperative and postoperative surgical complications after ureteroscopy, retrograde intrarenal surgery, and percutaneous nephrolithotomy: a systematic review. Minerva urology and nephrology. 2021;73(3):309-332. https://doi.org/10.23736/s2724-6051.21.04294-4
• 5. Bhojani N, Miller LE, Bhattacharyya S, et al. Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis. Journal of endourology. 2021;35(7):991-1000. https://doi.org/10.1089/end.2020.1133
• 6. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratislavske lekarske listy. 2001;102(1):5-14.
• 7. Han X, Liu S, Yang G, et al. Prognostic value of systemic hemato-immunological indices in uterine cervical cancer: A systemic review, meta-analysis, and meta-regression of observational studies. Gynecologic oncology. 2021;160(1):351-360. https://doi.org/10.1016/j.ygyno.2020.10.011
• 8. Finch W, Johnston R, Shaida N, et al. Measuring stone volume - three-dimensional software reconstruction or an ellipsoid algebra formula?. BJU Int. 2014;113(4):610-614. https://doi.org/10.1111/bju.12456
• 9. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 23 2016;315(8):801-10. https://doi.org/10.1001/jama.2016.0287
• 10. Wagenlehner FM, Lichtenstern C, Rolfes C, et al. Diagnosis and management for urosepsis. Int J Urol. 2013;20(10):963-970. https://doi.org/10.1111/iju.12200
• 11. Dybowski B, Bres-Niewada E, Rzeszutko M, et al. Risk factors for infectious complications after retrograde intrarenal surgery - a systematic review and narrative synthesis. Central European journal of urology. 2021;74(3):437-445. https://doi.org/10.5173/ceju.2021.250
• 12. Bhojani N, Miller LE, Bhattacharyya S, et al. Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis. J Endourol. 2021;35(7):991-1000. https://doi.org/10.1089/end.2020.1133
• 13. Gauhar V, Chew BH, Traxer O, et al. Indications, preferences, global practice patterns and outcomes in retrograde intrarenal surgery (RIRS) for renal stones in adults: results from a multicenter database of 6669 patients of the global FLEXible ureteroscopy Outcomes Registry (FLEXOR). World journal of urology. 2023;41(2):567-574. https://doi.org/10.1007/s00345-022-04257-z
• 14. Corrales M, Sierra A, Doizi S, et al. Risk of Sepsis in Retrograde Intrarenal Surgery: A Systematic Review of the Literature. European urology open science. 2022;44:84-91. https://doi.org/10.1016/j.euros.2022.08.008
• 15. Xu Y, Min Z, Wan SP, et al. Complications of retrograde intrarenal surgery classified by the modified Clavien grading system. Urolithiasis. 2018;46(2):197-202. https://doi.org/10.1007/s00240-017-0961-6
• 16. Moses RA, Ghali FM, Pais VM, et al. Unplanned Hospital Return for Infection following Ureteroscopy-Can We Identify Modifiable Risk Factors? The Journal of urology. 2016;195(4 Pt 1):931-6. https://doi.org/10.1016/j.juro.2015.09.074
• 17. Zhang J, Zhang L, Duan S, et al. Single and combined use of the platelet-lymphocyte ratio, neutrophil-lymphocyte ratio, and systemic immune-inflammation index in gastric cancer diagnosis. Frontiers in oncology. 2023;13:1143154. https://doi.org/10.3389/fonc.2023.1143154
• 18. Karadeniz F, Karadeniz Y, Altuntaş E. Systemic immune-inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome. Cardiovascular journal of Africa. 2023;34:1-7. https://doi.org/10.5830/cvja-2023-011
• 19. Gokce SF, Bolayır A, Cigdem B, et al. The role of systemic ımmune ınflammatory ındex in showing active lesion ın patients with multiple sclerosis: SII and other inflamatuar biomarker in radiological active multiple sclerosis patients. BMC neurology. 2023;23(1):64. https://doi.org/10.1186/s12883-023-03101-0
• 20. Xu JP, Zeng RX, Zhang YZ, et al. Systemic inflammation markers and the prevalence of hypertension: A NHANES cross-sectional study. Hypertension research : official journal of the Japanese Society of Hypertension. 2023;46(4):1009-1019. https://doi.org/10.1038/s41440-023-01195-0
• 21. Mangalesh S, Dudani S, Malik A. The systemic immune-inflammation index in predicting sepsis mortality. Postgraduate medicine. 2023;135(4):345-351. https://doi.org/10.1080/00325481.2022.2140535
• 22. Kosidło JW, Wolszczak-Biedrzycka B, Matowicka-Karna J, et al. Clinical Significance and Diagnostic Utility of NLR, LMR, PLR and SII in the Course of COVID-19: A Literature Review. Journal of inflammation research. 2023;16:539-562. https://doi.org/10.2147/jir.S395331
• 23. Kriplani A, Pandit S, Chawla A, et al. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) in predicting systemic inflammatory response syndrome (SIRS) and sepsis after percutaneous nephrolithotomy (PNL). Urolithiasis. 2022;50(3):341-348. https://doi.org/10.1007/s00240-022-01319-0