Category: Clinical Stones: PCNL
Introduction & Objective :
Urolithiasis is a common urological disease with a 10% lifetime incidence, prevalence continues to rise worldwide. Percutaneous nephrolithotomy (PCNL) is standard treatment for renal stones >2cm and staghorn calculi. PCNL is associate with higher stone clearance and perioperative complications. Many studies evaluate factors of lithiasis when predicting risk of postoperative sepsis, there are fewer studies which consider clinical information.
Hypoalbuminaemia is associated with increased morbidity and mortality in sepsis. There is little data available regarding the role of hypoalbuminaemia in predicting sepsis following PCNL. Low serum albumin is predictive for microbial infection in febrile patients. Yang et al (2017) suggest high levels of serum albumin may protect against fever following PCNL.
This study aims to review if low serum albumin levels can help predict postoperative sepsis following PCNL.
A retrospective audit of prospectively collected data was gathered from review of clinical and operative notes from patients undergoing percutaneous nephrolithotomy by a single surgeon between September 2012 and November 2016. Patient demographics, preoperative blood biochemistry, operative factors, lithiasis factors and post operative sepsis were recorded.
181 patients underwent PCNL over a 4 year period, 32 patients showed signs of infection ranging from post operative fever to septic shock requiring management by intensivists. Table 1 illustrates abnormal pre-operative serum albumin levels in both septic and non-septic patients. (Normal range 35-50g/dl).
Statistical analysis was done using a CHI-squared test , p <0.05 showing low preoperative serum albumin was significant in predicting patients at risk of sepsis following PCNL.
There are many recognised factors which predict risk of sepsis following PCNL. Hypoalbuminaemia increases the risk of morbidity and mortality in sepsis. This study shows a significant difference in sepsis rates between patients with hypoalbuminaemia and those with serum albumin withinthe normal range.
Further work is required to determine the role of albumin in sepsis post PCNL but we demonstrate a trend which requires consideration and has encouraged preoperative nutritional optimisation.
Caroline Bradley– Academic Foundation Year 2, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
Lynne Kerr– ST5, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
Jane Hendry– Glasgow, Scotland, United Kingdom
Gareth Jones– Glasgow, Scotland, United Kingdom
Academic Foundation Year 2
NHS Greater Glasgow and Clyde
Glasgow, Scotland, United Kingdom
Dr Caroline Bradley, MBChB BMedSci (Hons)
Academic Foundation Year 2, NHS Greater Glasgow and Clyde
Currently working at the Beatson West of Scotland Cancer Centre