Preoperative albumin-globulin ratio predicts systemic inflammatory reaction after percutaneous nephrolithotomy

CHINA: According to a study reported in the International Journal of General Medicine, preoperative albumin-globulin ratio is a potential predictor of the development of systemic inflammatory response syndrome following percutaneous nephrolithotomy.

There are significant health and financial costs associated with urolithiasis, which is a condition that affects people all over the world. According to the recommendations of the European Association of Urology, percutaneous nephrolithotomy (PCNL) is the best course of action for treating complicated kidney stones. Following PCNL, systemic inflammatory response syndrome (SIRS) is a frequent complication that has been linked to 7% to 31% of fatalities. Determining certain risk variables for post-PCNL SIRS in individuals with renal stones is crucial.

"The identification of post-PCNL SIRS risk factors to limit its occurrence has captured the urologists' interest recently. Older age, preoperative positive urine culture, larger stone, female sex, and longer surgical time are widely recognized as potential risk factors for SIRS after PCNL, though results from diverse research are not always consistent, "the researchers reported.

This investigation sought to determine how well the preoperative albumin-globulin ratio (AGR) predicted the development of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL).

A retrospective review of 354 patients who had PCNL at the Guizhou Provincial People's Hospital between August 2017 and July 2019 was conducted for this purpose. The development of SIRS within 48 hours after PCNL was the study's main clinical outcome. The predictive significance of AGR for post-PCNL SIRS was confirmed using univariable and multivariable logistic regression models. To evaluate the discriminatory power of AGR with other inflammatory biomarkers, receiver operating characteristic (ROC) curves were also constructed.

Key findings of the trial:

• In 66 patients (18.64%), postoperative SIRS occurred. The patients did not get postoperative sepsis.
• According to a multivariate study, female sex, CRP, and AGR were all independently predictive factors for SIRS following PCNL (odds ratio [OR]=2.939, 95% odds ratio [OR]: 1.368- 6.315, p = 0.006, and OR = 1.008, 95% CI: 1.003-1.012, respectively).
• The AGR cut-off value of 1.145 was the most effective for predicting postoperative SIRS.
• Furthermore, AGR outperformed C-reactive protein in terms of sensitivity (83.3%), specificity (88.9%), and area under the curve (0.844). (0.808).

The authors claimed that despite all of their efforts, "a new effective and reliable indicator still demands additional investigation to further increase the sensitivity and specificity of prediction."

They came to the conclusion that patients with AGR < 1.145 should undergo rigorous evaluation and treatment prior to receiving PCNL.

REFERENCE

Wang Q, Jiang K, Chen X, Zeng G, Sun F. The Predictive Value of Preoperative Albumin–Globulin Ratio for Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy. Int J Gen Med. 2022;15:7407-7415

https://doi.org/10.2147/IJGM.S379741