Preoperative inflammatory biomarkers analysis in prognosis of systemic inflammatory response syndrome following percutaneous nephrolithotomy: A systematic review and meta-analysis

INTRODUCTION: Urosepsis is one of the most serious complications of percutaneous nephrolithotomy (PCNL). To date, many studies aim to prescreen urosepsis possibility after PCNL through blood components. This meta-analysis aims to determine C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) obtained preoperatively used to predict postoperative sepsis after PCNL. METHODS: A comprehensive literature search was performed through the electronic databases in March 2022. The quality of the included studies was assessed with Newcastle Ottawa Scale (NOS), while the presence of publication bias was assessed using Begg’s and Egger’s tests. Quantitative analysis was performed using RevMan 5.4 and Comprehensive Meta-Analysis 3.0. The outcome of interest is the difference in blood component count between groups that experienced systemic inflammatory response syndrome (SIRS) and those who did not. Acquired data were pooled as mean difference (MD). RESULTS: Total of 11 studies were included in the quantitative analysis. Leukocyte count showed an increase between the group that experienced SIRS and those who were not (MD 0.69, 95% confidence interval [CI] 0.48 to 0.91, p < 0.00001). Similar result was also found in other analysis, CRP (MD 3.30, 95% [CI] 2.33 to 4.26, p < 0.00001), NLR (MD 0.59, 95% [CI] 0.48 to 0.69, p < 0.00001), and PLR (MD 23.40, 95% [CI] 17.98 to 28.82, p < 0.00001). CONCLUSION: Preoperative PLR, NLR, and CRP had significant association with postoperative sepsis after PCNL. It is beneficial for urologists to ensure close monitoring of these biomarkers levels before PCNL. The result of this study might serve as a consideration for future clinical approaches in determining beneficial treatment for urolithiasis patients.