scholarly journals Should renal pelvic urine culture be obtained routinely in flexible ureterorenoscopy?

2021 ◽  
Author(s):  
Omer Koras ◽  
Serkan Yarımoğlu ◽  
Salih Polat ◽  
Fatih Gokalp ◽  
Murat Sahan ◽  
...  
Keyword(s):  
Urine Culture ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Ureteral Stones ◽  
Characteristic Analysis ◽  
Flexible Ureterorenoscopy ◽  
The Two Cultures ◽  
Standard Application ◽  
Pelvic Urine ◽  
Bladder Urine

Background: Preoperative bladder urine culture (PBUC) analysis has become a standard application before any stone surgery. When growth is detected in PBUC, it is contraindicated to perform flexible ureterorenoscopy (f-URS). The results of the PBUC susceptibility test do not correlate well with those of the renal pelvic urine culture (RPUC) analysis. Previous studies have demonstrated the positivity of RPUC as an important marker for the development of infections after endoscopic operations. In the current study, we aimed to evaluate the consistency between PBUC and RPUC and to identify preoperative markers associated with a positive RPUC. Methods: Data from 129 patients who underwent f-URS on renal and proximal ureteral stones in two centers between 2015 and 2020 were prospectively recorded in a database and retrospectively analyzed. PBUC was obtained from all the patients preoperatively, and RPUC was taken at the beginning of the f-URS operation. The results of the two cultures were compared. Results: There was growth in PBUC in 25 (19.4%) patients and RPUC in 35 (27.1%) patients. Possible predictive markers in predicting a positive RPUC were evaluated using multivariate logistic regression analysis. Preoperative urine density at the renal pelvis [odds ratio (OR): 0.848, p<0.001],grade≥2 hydronephrosis (OR:18.970,p=0.001), and lower calyceal stone localization (OR:0.033,p=0.017) were determined as independent predictive factors for a positive RPUC. The ability of pelvis urine density to predict positive RPUC positivity was evaluated using the receiver operating characteristic analysis, in which the area under the curve value was determined to be 0.858 (0.780-0.936). The cut-off value of pelvis urine density in the prediction of RPUC positivity was 4.5, at which it had 80% sensitivity and 77.7% specificity. Conclusions: PBUC may not represent true colonization. Although bladder urine culture is negative before the operation, patients with preoperative hydronephrosis and low pelvis urine density may have RPUC growth.

scholarly journals A prospective Comparative Clinical Study on Bladder Urine, Pelvic Urine and Renal Stone Culture & Sensitivity in Predicting Urosepsis Following Percutaneous Nephrolithotomy

2020 ◽  
Vol 3 (1) ◽  
pp. 75-79
Author(s):  
V. Vijay Kumar Reddy ◽  
Vijaya Bhaskar Reddy.G
Keyword(s):  
Septic Shock ◽  
Clinical Study ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Percutaneous Nephrolithotomy ◽  
Urine Culture ◽  
Stone Culture ◽  
Culture And Sensitivity ◽  
Pelvic Urine ◽  
Bladder Urine

Background: Urosepsis means a severe infection of urinary tract (UTI) and/or male genital tract (prostate) with features consistent with systemic inflammatory response syndrome. UTI may occur among all the age groups and produce a broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with gram negative sepsis to septic shock. It is estimated that the mortality rate due to urosepsis ranges from 30 to 40 p.c respectively. Urosepsis may also cause multiple organ dysfunction, hypoperfusion or hypotension. Urosepsis due to percutaneous nephrolithotomy may be catastrophic despite prophylactic antibiotic coverage and negative midstream urine culture and sensitivity testing (C&S) and bacteria in the stone can be responsible for systemic infection. The aim of the study is to compare bladder urine (culture      & sensitivity) and collecting system urine and stone (culture and sensitivity) in predicting urosepsis following percutaneous nephrolithotomy. Subjects and Methods: A hospital-based, analytical prospective clinical study was conducted among thirty cases who were present during   the study period and had undergone percutaneous nephrolithotomy (PCNL). Cases were included irrespective of gender with renal calculi       in whom percutaneous nephrolithotomy was about to be done at Narayana Medical College & Hospital, Chintareddypalem, Nellore, Andhra Pradesh during 1st February 2014 to 31st January 2015. Data collected was divided into three main groups Midstream urine (C&S); Pelvic urine (C&S); and Stone (C&S) respectively. Data obtained was entered in Microsoft Excel-2013 and analyzed in SPSS version-22 trial. Appropriate statistical tests were applied and p-value less than 0.05 was considered as significant. Results: Bladder urine (C&S) was positive in 3/30 (10.00%) patients, Pelvic urine (C&S) in 5/30 (16.66 %) patients and Stone (C&S) in 8/30 (26.66 %) patients. Most of the infected specimens grew Escherichia coli followed by pseudomonas, klebsiella, enterococcus. Systemic Inflammatory Response Syndrome (SIRS) was reported among 26.7 p.c (8) of the patients. In one patient (3.33%) septic shock developed but no deaths were reported. Conclusion: Stone (C&S) and Pelvic urine (C&S) are better predictors of urosepsis than Bladder urine (C&S).

scholarly journals A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9435
Author(s):  
Yang Xun ◽  
Yuanyuan Yang ◽  
Xiao Yu ◽  
Cong Li ◽  
Junlin Lu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Percutaneous Nephrolithotomy ◽  
Urine Culture ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Ureteral Stones ◽  
Positive Urine Culture ◽  
Positive Urine

Background Postoperative sepsis is a lethal complication for percutaneous nephrolithotomy (PCNL). An early predictive model combined local and systemic conditions is urgently needed to predict infectious events. We aim to determine the preoperative predictors of sepsis after PCNL in patients with unilateral, solitary, and proximal ureteral stones. Methods A total of 745 patients who underwent PCNL between January 2012 and December 2018 were retrospectively enrolled. Sepsis was defined based on the International Sepsis Definitions in 2001, and the preoperative factors were compared between the non-sepsis and sepsis groups. Univariable analysis and multivariable logistic regression analysis were conducted to determine the predictors for sepsis after PCNL. A nomogram was generated using the predictors. Results In this study, 35 patients (4.7%) developed sepsis after PCNL. Univariate analysis showed that post-PCNL sepsis was associated with the female, lower albumin, higher globulin, lower albumin globulin ratio (AGR < 1.5), preoperative fever, leukocytosis (WBC ≥ 10,000 cells/μL), positive urine culture, leukocyturia (≥50 cells/μL) and positive urine nitrite. Multivariate logistic regression analysis suggested that AGR < 1.5 (odds ratio [OR] = 5.068, 95% confidence interval [CI] [1.135–22.624], P = 0.033), positive urine culture (OR = 3.243, 95% CI [1.162–9.047], P = 0.025), leukocytosis (OR = 3.706, 95% CI [1.444–9.512], P = 0.006) and female (OR = 2.529, 95% CI [1.127–5.672], P = 0.024) were independent risk factors for sepsis. A nomogram was generated and displayed favorable fitting (Hosmer–Lemeshow test P = 0.797), discrimination (area under receiver operating characteristic curve was 0.807), and clinical usefulness by decision curve analysis. Conclusions Patients with certain preoperative characteristics, such as female, lower AGR, positive urine culture, and leukocytosis, who undergo PCNL may have a higher risk of developing sepsis. A cautious preoperative evaluation and optimized treatment strategy should be considered in these patients to minimize infectious complications.

Abstract 291: Galectin-3 as a Risk Predictor of Short-Term Mortality in the Resuscitated Cohorts of Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Zaid Al Jebaje ◽  
Umesh C Sharma ◽  
Wassim Mosleh ◽  
Milind Chaudhari
Keyword(s):  
Cardiac Arrest ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Mortality Prediction ◽  
First Episode ◽  
Characteristic Analysis ◽  
Shockable Rhythm ◽  
Galectin 3 ◽  
Hospital Cardiac Arrest

Introduction: Out of Hospital Cardiac Arrest (OHCA) is a common and catastrophic manifestation of multiple cardiac and non-cardiac illnesses. Recent studies showed increase in survival rate, reaching to about one third of those who suffer a bystander witnessed OHCA with a shockable rhythm; yet biomarkers to predict outcomes in this group is still missing. Hypothesis: We tested the hypothesis that serum galectin-3, alone or together with galectin-3 binding protein (G3BP),brain natriuretic peptide (BNP) and troponin, can predict the risk of early (30-day) mortality in ResCOHS. Methods: ResCOHS prospective multicenter pilot study enrolled 117 patients with aborted out-of-hospital cardiac arrest, and 10 healthy volunteers. Transthoracic Echocardiogram was performed for cardiac morphology and function. Serum levels of galectin-3, G3BP, BNP and peak troponin were analyzed. Patients were prospectively followed up for 30-days to determine all-cause in-hospital mortality. Results: Among the ResCOHS, patients who died within 30-days had higher BNP and galectin-3 levels, with no differences in the G3BP, peak troponin, CK and CK-MB levels. Receiver operating characteristic analysis for mortality prediction showed that, for 30-day prognosis, galectin-3 had the greatest area under the curve (AUC) at 0.764 (p = 0.001), whereas G3BP, BNP and troponin had an AUC of 0.518 (p = 0.735), 0.759 (p = 0.001)and 0.540 (p=0.460) respectively. In a multivariate logistic regression analysis, an elevated level of galectin-3 was the strongest independent predictor of 30-day mortality (odds ratio 1.04, p = 0.002). The Kaplan-Meier analyses showed that the combination of an elevated galectin-3 with NT-proBNP was a better predictor of mortality than either of the 2 markers alone. Conclusions: In the ResCOHS, higher serum galectin-3 levels are associated with increased chances of death within 30-days of the first episode of cardiac arrest. These findings have implications to target specific therapies to those at the greatest risk of mortality after OHCA.

scholarly journals Comorbidity index for predicting mortality at 6 months after reperfusion therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyo Suk Nam ◽  
Young Dae Kim ◽  
Joonsang Yoo ◽  
Hyungjong Park ◽  
Byung Moon Kim ◽  
...  
Keyword(s):  
Prospective Cohort ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Reperfusion Therapy ◽  
Good Prediction ◽  
Multivariate Logistic Regression ◽  
Stroke Patients ◽  
Number Of Patients ◽  
Comorbidity Index ◽  
Using Data

AbstractThe eligibility of reperfusion therapy has been expanded to increase the number of patients. However, it remains unclear the reperfusion therapy will be beneficial in stroke patients with various comorbidities. We developed a reperfusion comorbidity index for predicting 6-month mortality in patients with acute stroke receiving reperfusion therapy. The 19 comorbidities included in the Charlson comorbidity index were adopted and modified. We developed a statistical model and it was validated using data from a prospective cohort. Among 1026 patients in the retrospective nationwide reperfusion therapy registry, 845 (82.3%) had at least one comorbidity. As the number of comorbidities increased, the likelihood of mortality within 6 months also increased (p < 0.001). Six out of the 19 comorbidities were included for developing the reperfusion comorbidity index on the basis of the odds ratios in the multivariate logistic regression analysis. This index showed good prediction of 6-month mortality in the retrospective cohort (area under the curve [AUC], 0.747; 95% CI, 0.704–0.790) and in 333 patients in the prospective cohort (AUC, 0.784; 95% CI, 0.709–0.859). Consideration of comorbidities might be helpful for the prediction of the 6-month mortality in patients with acute ischemic stroke who receive reperfusion therapy.

scholarly journals Measles Virus IgG Avidity Assay for Use in Classification of Measles Vaccine Failure in Measles Elimination Settings

2012 ◽  
Vol 19 (11) ◽  
pp. 1810-1817 ◽  
Author(s):  
Sara Mercader ◽  
Philip Garcia ◽  
William J. Bellini
Keyword(s):  
Measles Virus ◽  
Area Under The Curve ◽  
Epidemiological Data ◽  
Diagnostic Tools ◽  
High Avidity ◽  
Characteristic Analysis ◽  
Vaccine Failure ◽  
Avidity Assay ◽  
Igg Avidity

ABSTRACTIn regions where endemic measles virus has been eliminated, diagnostic assays are needed to assist in correctly classifying measles cases irrespective of vaccination status. A measles IgG avidity assay was configured using a commercially available measles-specific IgG enzyme immunoassay by modifying the protocol to include three 5-min washes with diethylamine (60 mM; pH 10.25) following serum incubation; serum was serially diluted, and the results were expressed as the end titer avidity index. Receiver operating characteristic analysis was used for evaluation and validation and to establish low (≤30%) and high (≥70%) end titer avidity thresholds. Analysis of 319 serum specimens expected to contain either high- or low-avidity antibodies according to clinical and epidemiological data indicated that the assay is highly accurate, with an area under the curve of 0.998 (95% confidence interval [CI], 0.978 to 1.000), sensitivity of 91.9% (95% CI, 83.2% to 97.0%), and specificity of 98.4% (95% CI, 91.6% to 100%). The assay is rapid (<2 h) and precise (standard deviation [SD], 4% to 7%). In 18 samples from an elimination setting outbreak, the assay identified 2 acute measles cases with low-avidity results; both were IgM-positive samples. Additionally, 11 patients (15 samples) with modified measles who were found to have high-avidity IgG results were classified as secondary vaccine failures; one sample with an intermediate-avidity result was not interpretable. In elimination settings, measles IgG avidity assays can complement existing diagnostic tools in confirming unvaccinated acute cases and, in conjunction with adequate clinical and epidemiologic investigation, aid in the classification of vaccine failure cases.

scholarly journals Head-to-Head Comparison of Two Nomograms Predicting Probability of Lymph Node Invasion in Prostate Cancer and the Therapeutic Impact of Higher Nomogram Threshold

2021 ◽  
Vol 10 (5) ◽  
pp. 999
Author(s):  
Zilvinas Venclovas ◽  
Tim Muilwijk ◽  
Aivaras J. Matjosaitis ◽  
Mindaugas Jievaltas ◽  
Steven Joniau ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Area Under The Curve ◽  
Pelvic Lymph Node ◽  
Cancer Center ◽  
Study Cohort ◽  
Net Benefit ◽  
Characteristic Analysis ◽  
Therapeutic Impact ◽  
Mskcc Nomogram

Introduction: The aim of the study was to compare the performance of the 2012 Briganti and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms as a predictor for pelvic lymph node invasion (LNI) in men who underwent radical prostatectomy (RP) with pelvic lymph node dissection (PLND), to examine their performance and to analyse the therapeutic impact of using 7% nomogram cut-off. Materials and Methods: The study cohort consisted of 807 men with clinically localised prostate cancer (PCa) who underwent open RP with PLND between 2001 and 2019. The area under the curve (AUC) of the receiver operator characteristic analysis was used to quantify the accuracy of the 2012 Briganti and MSKCC nomograms to predict LNI. Calibration plots were used to visualise over or underestimation by the models and a decision curve analysis (DCA) was performed to evaluate the net benefit associated with the used nomograms. Results: A total of 97 of 807 patients had LNI (12%). The AUC of 2012 Briganti and MSKCC nomogram was 80.6 and 79.2, respectively. For the Briganti nomogram using the cut-off value of 7% would lead to reduce PLND in 47% (379/807), while missing 3.96% (15/379) cases with LNI. For the MSKCC nomogram using the cut-off value of 7% a PLND would be omitted in 44.5% (359/807), while missing 3.62% (13/359) of cases with LNI. Conclusions: Both analysed nomograms demonstrated high accuracy for prediction of LNI. Using a 7% nomogram cut-off would allow the avoidance up to 47% of PLNDs, while missing less than 4% of patients with LNI.

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