To create a machine-learning model for estimating the likelihood of post-retrograde intrarenal surgery (RIRS) sepsis.
All consecutive patients with kidney stone(s) only undergoing RIRS in 16 centers were prospectively included (January 2022-August 2023).
adult, renal stone(s) only, CT scan (within three months), mid-stream urine culture (within 10 days).
concomitant ureteral stone, bilateral procedures. In case of symptomatic infection/asymptomatic bacteriuria, patients were given six days of antibiotics according to susceptibility profiles. All patients had antibiotics prophylaxis. Variables selected for the model: age, gender, age-adjusted Charlson Comorbidity Index, stone volume, indwelling preoperative bladder catheter, urine culture, single/multiple stones, indwelling preoperative stent/nephrostomy, ureteric access sheath, surgical time. Analysis was conducted using Python programming language, with Pandas library and machine learning models implemented using the Scikit-learn library. Machine learning algorithms tested: Decision Tree, Random Forest, Gradient Boosting. Overall performance was accurately estimated by K-Fold cross-validation with three folds.
1552 patients were included. There were 20 (1.3%) sepsis cases, 16 (1.0%) septic shock cases, and three more cases (0.2%) of sepsis-related deaths. Random Forest model showed the best performance (precision = 1.00; recall = 0.86; F1 score = 0.92; accuracy = 0.92). A web-based interface of the predictive model was built and is available at https://emabal.pythonanywhere.com/ CONCLUSIONS: Our model can predict post-RIRS sepsis with high accuracy and might facilitate patient selection for day-surgery procedures and identify patients at higher risk of sepsis who deserve extreme attention for prompt identification and treatment.
World journal of urology. 2024 Nov 01*** epublish ***
Daniele Castellani, Virgilio De Stefano, Carlo Brocca, Giorgio Mazzon, Antonio Celia, Andrea Bosio, Claudia Gozzo, Eugenio Alessandria, Luigi Cormio, Runeel Ratnayake, Andrea Vismara Fugini, Tonino Morena, Yiloren Tanidir, Tarik Emre Sener, Simon Choong, Stefania Ferretti, Andrea Pescuma, Salvatore Micali, Nicola Pavan, Alchiede Simonato, Roberto Miano, Luca Orecchia, Giacomo Maria Pirola, Angelo Naselli, Esteban Emiliani, Pedro Hernandez-Peñalver, Michele Di Dio, Claudio Bisegna, Davide Campobasso, Emauele Serafin, Alessandro Antonelli, Emanuele Rubilotta, Deepak Ragoori, Emanuele Balloni, Marina Paolanti, Vineet Gauhar, Andrea Benedetto Galosi
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona, 60126, Italy. ., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona, 60126, Italy., Urology Unit, ULSS 7 Pedemontana, Bassano del Grappa, Vicenza, Italy., Department of Urology, Città della Salute e della Scienza Molinette University Hospital, Turin, Italy., Andrology and Urology Unit, L. Bonomo Hospital, Andria, Italy., Urology Unit, Fondazione Poliambulanza Hospital, Brescia, Italy., Department of Urology, Marmara University School of Medicine, Istanbul, Turkey., Institute of Urology, University College Hospitals of London, London, UK., Department of Urology, University of Modena and Reggio Emilia, Modena, Italy., Urology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy., Urology Unit, AOU Policlinico Tor Vergata, Rome, Italy., Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy., Department of Urology, Fundació Puigvert (IUNA), Autonoma University of Barcelona, Barcelona, Spain., Division of Urology, Department of Surgery, Annunziata Hospital, Cosenza, Italy., Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, Verona, Italy., Department Urology, Asian Institute of Nephrology and Urology, Hyderabad, India., Department of Information Engineering, Università Politecnica delle Marche, Ancona, Italy., Department of Political Science, Communication and International Relations, University of Macerata, Macerata, Italy., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.