To evaluate association between postoperative serum procalcitonin (PCT) levels and infectious complications following mini-percutaneous nephrolithotomy (mini-PCNL), and to identify predictors of elevated PCT.
We retrospectively analyzed 496 adult patients who underwent mini-PCNL for kidney stones (February 2020-March 2025). Patients were stratified into four groups based on postoperative fever occurrence and PCT levels (≤ 2.0 ng/ml vs. > 2.0 ng/ml): Group 1 (no fever, low PCT, n = 404), Group 2 (fever, low PCT, n = 10), Group 3 (no fever, high PCT, n = 65), and Group 4 (fever, high PCT, n = 17). Multivariable logistic regression analysis identified factors associated with PCT levels > 2.0 ng/ml.
Elevated PCT occurred in 82 patients (16.5%). Groups 3 and 4 had significantly higher rates of positive preoperative urine cultures (46.2% and 64.7%) compared to Groups 1 and 2 (6.2% and 30%, p < 0.001). Positive stone cultures were more frequent in Group 3 (50.8%). Median PCT level was higher in Group 4 [38.00 (13.10-87.70) ng/mL] compared with Group 3 [18.10 (8.60-54.0) ng/mL]. Major infectious complications (Clavien ≥ 3) occurred exclusively in Group 4, including one sepsis-related death. Multivariable analysis revealed that positive preoperative urine culture (OR 6.72 95% CI 3.20-14.14) and stone culture (OR 4.83 95% CI 2.34-9.81) were independent predictors of elevated PCT.
Elevated PCT following mini-PCNL is associated with positive preoperative urine and stone cultures, regardless of fever presence. Several patients exhibit elevated PCT without clinical manifestation of infection, suggesting a subclinical infection. These findings support the integration of PCT for enhanced risk stratification and postoperative management following mini-PCNL.
World journal of urology. 2025 Aug 14*** epublish ***
Angelo Cormio, Daniele Castellani, Runeel Ratnayake, Domenico De Palma, Ruggiero Fiorella, Alessio De Gennaro, Mario Auciello, Giuseppe Albino, Gian Maria Busetto, Giuseppe Carrieri, Luigi Cormio
Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy., Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Via Conca 71, Ancona, 60126, Italy. ., Department of Urology and Andrology, Bonomo Teaching Hospital, Andria, Italy.
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