Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Significance of albumin to globulin ratio as a predictor of febrile urinary tract infection after ureteroscopic lithotripsy

  • Yi, Seung Yun (Department of Urology, Kyungpook National University Hospital) ;
  • Park, Dong Jin (Department of Urology, Dongguk University Gyeonju Hospital) ;
  • Min, Kyungchan (Department of Urology, Kyungpook National University Hospital) ;
  • Chung, Jae-Wook (Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital) ;
  • Ha, Yun-Sok (Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital) ;
  • Kim, Bum Soo (Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital) ;
  • Kim, Hyun Tae (Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital) ;
  • Kim, Tae-Hwan (Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital) ;
  • Yoo, Eun Sang (Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital)
  • Received : 2021.01.31
  • Accepted : 2021.03.19
  • Published : 2021.07.31
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Abstract

Background: We aimed to analyze the effectiveness of albumin to globulin ratio (AGR) in predicting postoperative febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URS) and retrograde intrarenal surgery (RIRS). Methods: From January 2013 to May 2018, 332 patients underwent URS and RIRS. The rate of postoperative fUTI and risk factors for postoperative fUTI were analyzed using logistic regression. Patients were divided into postoperative fUTI and non-postoperative fUTI (non-fUTI) groups. AGR with other demographic and perioperative data were compared between the two groups to predict the development of fUTI after URS. Results: Of the 332 patients, postoperative fUTI occurred in 41 (12.3%). Preoperative pyuria, microscopic hematuria, diabetes mellitus, hypoalbuminemia, and hyperglobulinemia were more prevalent in the fUTI group. Patients in the fUTI group had larger stone size, lower preoperative AGR, longer operation time, and longer preoperative antibiotic coverage period. In a multivariable logistic analysis, preoperative pyuria, AGR, and stone size were independently correlated with postoperative fUTI (p<0.001, p=0.008, and p=0.041, respectively). Receiver operating curve analysis showed that the cutoff value of AGR that could predict a high risk of fUTI after URS was 1.437 (sensitivity, 77.3%; specificity, 76.9%), while the cutoff value of stone size was 8.5 mm (sensitivity, 55.3%; specificity, 44.7%). Conclusion: This study demonstrated that preoperative pyuria, AGR, and stone size can serve as prognostic factors for predicting fUTI after URS.

Keywords

Acknowledgement

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) & funded by the Korean government (MSIT) (2019R1F1A1044473) (2019R1H1A1079839) (2020R1I1A3071568).

References

  1. Baseskioglu B. The prevalence of urinary tract infection following flexible ureterenoscopy and the associated risk factors. Urol J 2019;16:439-42.
  2. Senocak C, Ozcan C, Sahin T, Yilmaz G, Ozyuvali E, Sarikaya S, et al. Risk factors of infectious complications after flexible uretero-renoscopy with laser lithotripsy. Urol J 2018;15:158-63.
  3. Knopf HJ, Graff HJ, Schulze H. Perioperative antibiotic prophylaxis in ureteroscopic stone removal. Eur Urol 2003;44:115-8. https://doi.org/10.1016/S0302-2838(03)00189-1
  4. Cetinkaya M, Buldu I, Kurt O, Inan R. Platelet-to-lymphocyte ratio: a new factor for predicting systemic inflammatory response syndrome after percutaneous nephrolithotomy. Urol J 2017;14:4089-93.
  5. Sen V, Bozkurt IH, Aydogdu O, Yonguc T, Yarimoglu S, Sen P, et al. Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy. Kaohsiung J Med Sci 2016;32:507-13. https://doi.org/10.1016/j.kjms.2016.08.008
  6. He J, Pan H, Liang W, Xiao D, Chen X, Guo M, et al. Prognostic effect of albumin-to-globulin ratio in patients with solid tumors: a systematic review and meta-analysis. J Cancer 2017;8:4002-10. https://doi.org/10.7150/jca.21141
  7. Fan S, Gong B, Hao Z, Zhang L, Zhou J, Zhang Y, et al. Risk factors of infectious complications following flexible ureteroscope with a holmium laser: a retrospective study. Int J Clin Exp Med 2015;8:11252-9.
  8. Lai WS, Assimos D. Factors associated with postoperative infection after percutaneous nephrolithotomy. Rev Urol 2018;20:7-11.
  9. Li T, Sun XZ, Lai DH, Li X, He YZ. Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: Risk factors and predictive model. Kaohsiung J Med Sci 2018; 34:400-8. https://doi.org/10.1016/j.kjms.2018.01.002
  10. Azab BN, Bhatt VR, Vonfrolio S, Bachir R, Rubinshteyn V, Alkaied H, et al. Value of the pretreatment albumin to globulin ratio in predicting long-term mortality in breast cancer patients. Am J Surg 2013;206:764-70. https://doi.org/10.1016/j.amjsurg.2013.03.007
  11. Du XJ, Tang LL, Mao YP, Sun Y, Zeng MS, Kang TB, et al. The pretreatment albumin to globulin ratio has predictive value for long-term mortality in nasopharyngeal carcinoma. PLoS One 2014;9:e94473. https://doi.org/10.1371/journal.pone.0094473
  12. Duran AO, Inanc M, Karaca H, Dogan I, Berk V, Bozkurt O, et al. Albumin-globulin ratio for prediction of long-term mortality in lung adenocarcinoma patients. Asian Pac J Cancer Prev 2014;15:6449-53. https://doi.org/10.7314/APJCP.2014.15.15.6449
  13. Jian ZY, Ma YC, Liu R, Li H, Wang K. Preoperative positive urine nitrite and albumin-globulin ratio are independent risk factors for predicting postoperative fever after retrograde Intrarenal surgery based on a retrospective cohort. BMC Urol 2020;20:50. https://doi.org/10.1186/s12894-020-00620-7
  14. Xun Y, Yang Y, Yu X, Li C, Lu J, Wang S. A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones. PeerJ 2020;8:e9435. https://doi.org/10.7717/peerj.9435
  15. Ulldemolins M, Roberts JA, Rello J, Paterson DL, Lipman J. The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients. Clin Pharmacokinet 2011;50:99-110. https://doi.org/10.2165/11539220-000000000-00000
  16. Codina Cazador A, Salva Lacombe JA, Fernandez-Llamazares Rodriguez J, Ruiz Feliu B, Codina Barreras A, Moreno Aguado V. Immunoglobulins and the complement system in colorectal cancer. Rev Esp Enferm Apar Dig 1989;75:143-8.
  17. Cohen MH, Makuch R, Johnston-Early A, Ihde DC, Bunn PA Jr, Fossieck BE Jr, et al. Laboratory parameters as an alternative to performance status in prognostic stratification of patients with small cell lung cancer. Cancer Treat Rep 1981;65:187-95.
  18. Zhang W, Zhangyuan G, Wang F, Zhang H, Yu D, Wang J, et al. High preoperative serum globulin in hepatocellular carcinoma is a risk factor for poor survival. J Cancer 2019;10:3494-500. https://doi.org/10.7150/jca.29499
  19. Du XJ, Tang LL, Mao YP, Guo R, Sun Y, Lin AH, et al. Circulating EBV DNA, globulin and nodal size predict distant metastasis after intensity-modulated radiotherapy in stage II nasopharyngeal carcinoma. J Cancer 2016;7:664-70. https://doi.org/10.7150/jca.14183
  20. Zhou T, He X, Fang W, Zhan J, Hong S, Qin T, et al. Pretreatment albumin/globulin ratio predicts the prognosis for smallcell lung cancer. Medicine (Baltimore) 2016;95:e3097. https://doi.org/10.1097/MD.0000000000003097
  21. Zhang Y, Wang L, Lin S, Wang R. Preoperative albumin-to-globulin ratio as a significant prognostic indicator in urologic cancers: a meta-analysis. Cancer Manag Res 2018;10:4695-708. https://doi.org/10.2147/CMAR.S178271