Blood Parameters as a Predictor of Fever After Percutaneous Nephrolithotomy

Study Overview
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Brief Summary
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To investigate the relationship between neutrophil count, lymphocyte count, neutrophil-to-lymphocyte count ratio (NLR), and postoperative fever in patients undergoing percutaneous nephrolithotomy (PNL).

Detailed Description
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Percutaneous nephrolithotomy (PNL) is a minimally invasive treatment commonly used for renal calculi. However, the prevalence of postoperative fever is reported to be 16.7%-35%, even with appropriate prophylactic antibiotic therapy and a sterile urine culture. The most probable causes are urinary extravasation and bacteremia. Although it is important to postoperatively isolate the causative bacteria, bacterial isolation may not always be possible, and urinary and blood cultures may prove negative. In addition, establishing the etiology of fever could be time-consuming and the techniques involved may generate pseudo-negative results owing to several factors, especially the antibiotics used prophylactically. This can result in a prolonged hospital stay and increased the cost of patient care. The most commonly used parameters for the early diagnosis of bacterial infections, despite their limited use, are C-reactive protein, white blood cell count, and neutrophil count . Superior parameters include procalcitonin, pro-adrenomedullin, interleukin (IL)-6, and IL-8, but their use is limited by their lack of availability in some centers and their higher costs. Recently, the ratio of neutrophil count to lymphocyte count (NLR) has been proposed as an effective, simple, and useful biomarker for the early diagnosis of bacterial infections. However, these tests are used after the emergence of fever. As yet, no single parameter has been proposed for predicting postoperative fever in the absence of preoperative factors known to cause fever. The aim of this study was to investigate whether neutrophil count, lymphocyte count, and NLR obtained from routine preoperative blood tests could be used in predicting fever following PNL in patients with no risk factors for infection.

Official Title
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Neutrophil and Lymphocyte Counts and the Neutrophil-to-lymphocyte Ratio as a Predictor of Fever Following Percutaneous Nephrolithotomy in Patients Without Risk Factors

Conditions
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Urinary Tract Infection Bacterial, Nephrolithiasis

Intervention / Treatment
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* Diagnostic Test: peripheric blood count


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: underwent PNL operation preoperative white blood cell count between 4,000 and 12,000/µL Exclusion Criteria: preoperative urinary system obstruction proliferation in preoperative and/or postoperative urine culture preoperative and/or postoperative blood transfusions a preoperative urinary diversion and/or intervention the presence of a postoperative residual stone the presence of malignancy, the presence of a hematologic disease. patients with postoperative complications graded as Clavien 2 and above

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: fever<br>patients that have fever after PNL | Diagnostic Test: peripheric blood count<br>* preoperative peripheric blood count<br>|
| Active Comparator: No fever<br>Patients without fever after PNL | Diagnostic Test: peripheric blood count<br>* preoperative peripheric blood count<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| White blood cell count | white blood cell count | preoperative | 
| Neutrophil count | neutrophil count | preoperative | 
| N/L | ratio of neutrophil count to lymphocyte count | preoperative | 
| Lymphocyte count | Lymphocyte count | preoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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fever, bacteremia, lymphocytes, percutaneous nephrolithotomy, neutrophil-lymphocyte ratio