The role of neutrophil to lymphocyte ratio and procalcitonin in prediction of systemic inflammatory response syndrome and sepsis after percutaneous nephrolithotomy

Background: percutaneous nephrolithotomy (PCNL) is an effective and minimally invasive technique used in the treatment of kidney stones, but it carries the risk of intraoperative and postoperative complications such as bleeding, extravasation, systemic inflammatory response syndrome (SIRS) and sepsis.The current study was designed to assess the role of preoperative neutrophil lymphocyte ratio and procalcitonin in prediction of postoperative SIRS, sepsis and septic shock after PCNL for urolithiasis.Patients and Methods: This prospective observational study included 70 aged ≥ 18 years old who underwent percutaneous nephrolithotomy (PCNL) for renal stones. NLR and procalcitonin was recorded peroperative, at day 1 (day of surgery) and 2nd day.Patients were followed up after PCNL and were classified into non-SIRS/Sepsis group and SIRS/Sepsis group. Receiver operating characteristic (ROC) curve was analyzed to assess the ability of NLR and procalcitonin to predict SIRS and sepsis.Results: Both groups showed comparable results in the majority of preoperative and intraoperative data; however, the NLR and procalcitonin were significantly increased in SIRS/Sepsis group in comparison with non-SIRS/Sepsis group. Conclusion: Preoperative neutrophil lymphocyte ratio with cut off value > 2.5 and preoperative procalcitonin with cut off value > 0.25 (ng/ml) can predict SIRS and sepsis following PCNL surgery with sensitivity of 80% and 85% and specificity of 82.5% and 87.5% respectively.