AUA 2017: C-Reactive Protein and Erythrocyte Sedimentation Rate Predicts SIRS after Percutaneous Nephrolithotomy

Boston, MA ( Ganesan et al. described a study looking at laboratory test values in relation to systemic inflammatory response syndrome (SIRS) prior to percutaneous nephrolithotomy (PCNL). Their team hypothesized that preoperative elevations in ESR and CRP would predict patients who are likely to develop SIRS postoperatively. They included patients who underwent PCNL between 2012 and 2013, during which time they routinely ordered these tests preoperatively; primary endpoint was the development of SIRS in the immediate postoperative period.

A total of 107 PCNLs were included in the study; among this cohort, a third of the patients developed SIRS. Interestingly, the SIRS patients did have a significantly elevated ESR and CRP preoperatively compared to the non-SIRS group (ESR: 8.0 vs 5.5 mm/hr, p=0.07; CRP: 0.7 vs. 0.3 mg/dL, p=0.02). Their multivariate analysis did determine that these patients tend to have a greater likelihood of longer operative times. Additionally, in attempting to define cutoffs for practice, they note that a the preoperative ESR of 6.5mm/hr (sn. 70%, sp. 62%, NPV 80%) and CRP of 0.65 mg/dL (sn. 51%, sp. 69%, NPV 75%).

Based on these results, it seems that these two laboratory values may predict the risk of SIRS postoperatively. The authors suggest that this could be used to risk-stratify patients and guide the duration of antibiotic prophylaxis before PCNL. Although the data does support this potential, the cutoff definitions do seem to need better elucidation to be put into practice. Perhaps a prospective randomized study to validate the stated cutoffs would be ideal.

Presented by: Vishnu Ganesan

Authors: Vishnu Ganesan, Robert D. Brown, Juan Antonia Jimenez, Shubha De, Manoj Monga

Affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine

Written By: Shoaib Safiullah, MS4 for

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA