Analysis of Risk Factors and Construction of a Prediction Model for Preoperative Concurrent Pathogenic Pyuria in Patients With Ureteral Calculi - Report - MDSpire
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Analysis of Risk Factors and Construction of a Prediction Model for Preoperative Concurrent Pathogenic Pyuria in Patients With Ureteral Calculi
Risk Factors and Predictive Model for Preoperative Pathogenic Pyuria in Ureteral Stones
Overview
This study identified key risk factors for preoperative pyuria and pathogenic pyuria in patients with ureteral calculi (UC). A predictive model combining clinical indicators demonstrated good accuracy in assessing the risk of pathogenic pyuria, facilitating early intervention.
Background
Ureteral calculi (UC) are increasingly common and often complicated by urinary tract infections (UTIs), which can lead to severe outcomes such as urosepsis. Preoperative pyuria is a marker for infection, but urine culture confirmation of pathogenic infection is delayed, complicating timely management. Early identification of patients with pathogenic pyuria is critical to guide preoperative antibiotic therapy and reduce postoperative complications. This study addresses the gap in knowledge regarding preoperative pyuria and pathogenic pyuria risk factors in UC patients and develops a practical predictive tool.
Data Highlights
Parameter
Finding
Significance (P-value)
Preoperative pyuria prevalence
53.30% (630/1182 patients)
Independent risk factors for pyuria
Female gender, bilateral UC, stone size, hydronephrosis size
0.005, 0.007, <0.05, <0.05 respectively
Pathogenic pyuria among pyuria patients
21.43% (135/630 patients)
Independent risk factors for pathogenic pyuria
Female gender, diabetes mellitus, hydronephrosis size > 40 mm
<0.001, 0.032, 0.022 respectively
Predictive model performance (AUC)
0.764
Hosmer–Lemeshow test (goodness of fit)
P = 0.989
Key Findings
Preoperative pyuria was present in 53.3% of UC patients.
Female gender, bilateral ureteral stones, larger stone size, and increased hydronephrosis size independently predicted preoperative pyuria.
Among patients with pyuria, 21.43% had pathogenic pyuria confirmed by urine culture.
Female gender, comorbid diabetes mellitus, and hydronephrosis size greater than 40 mm were independent risk factors for pathogenic pyuria.
A predictive model incorporating these risk factors plus urinary white blood cells > 60/HPF showed good discrimination (AUC 0.764) and calibration.
Clinical Implications
Clinicians should consider female gender, diabetes status, and hydronephrosis size when evaluating UC patients preoperatively for pathogenic pyuria risk. The predictive model can guide early initiation of anti-infective therapy before urine culture results are available, potentially reducing perioperative infection complications and hospital stay duration. This approach supports more timely and targeted management of UC patients undergoing surgery.
Conclusion
This study elucidates important risk factors for preoperative pyuria and pathogenic pyuria in ureteral stone patients and presents a validated predictive model to facilitate early identification and intervention. Implementation of this model may improve clinical outcomes by enabling prompt preoperative infection management.
References
Evaluation of Risk Determinants and Development of a Predictive Model for Preoperative Pathogenic Pyuria in Individuals with Ureteral Stones
