LAUSR

OBJECTIVE To find out a better criterion to identify septic shock patients after flexible ureteroscopic lithotripsy. MATERIALS AND METHODS 2364 patients who underwent the flexible ureteroscopic lithotripsy procedure were enrolled in the study. The demographics and preoperative results of lab tests of the patients were collected preoperatively. The postoperative WBC, SIRS and qSOFA were assessed 2 hours after flexible ureteroscopic lithotripsy. The predictive efficacy was measured by sensitivity, specificity, positive and negative predictive value and area under the receiver's operating characteristic (AUROC). RESULTS A total of 15 (0.63%) patients developed septic shock. There were 86 (3.64%) patients who were SIRS positive and 69 (2.92%) patients who were qSOFA positive. The pre- and postoperative WBC ratio in septic shock patients was 2.50±1.55 and 0.69±0.24 in normal patients (p<0.001). For sensitivity and negative predictive value, all reached 100%. For specificity, qSOFA was 97.70%, SIRS was 96.98% and SIRS combining pre- and postoperative WBC ratio (new criterion) was 99.79%. The new criterion had statistically significant higher specificity compared to SIRS or qSOFA (p<0.001 for both), but when comparing SIRS and qSOFA, it had statistically insignificant specificity (p=0.142). For positive predictive value, qSOFA was 21.73%, SIRS was 17.44% and new criterion was 75%. qSOFA and SIRS had similar AUROC (0.989 for qSOFA and 0.985 for SIRS), both lower than new criterion (AUROC: 0.999). CONCLUSIONS SIRS combined with pre- and postoperative WBC ratio has a much better specificity and positive prediction value than SIRS or qSOFA alone. It has 99.79% specificity and 75% positive prediction value, and as high as 100% sensitivity and negative prediction value.