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Gender-related differences in the performance of sequential organ failure assessment (SOFA) to predict septic shock after percutaneous nephrolithotomy

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Abstract

The study aims to identify whether gender differences exist in the sequential organ failure assessment (SOFA) score to the extent of affecting its predictive accuracy for septic shock after percutaneous nephrolithotomy (PCNL). A retrospective study of 612 patients undergoing PCNL was performed. The SOFA scores of male and female groups were compared to identify any gender differences. The ROC curve was used to find differences between the original and adjusted SOFA scores. Postoperative septic shock developed in 21 (3.43%) cases. A marginally significant discrepancy in median SOFA scores between genders was discovered in a subgroup of patients < 40 years old (p = 0.048). A gender difference existed in the SOFA score after PCNL, with greater proportion of high scores in female patients (p = 0.011). Male patients had a higher proportion of ≥ 2 sub-score in hepatic and renal systems than female patients, caused by their higher preoperative bilirubin and creatinine (p < 0.05). An adjusted SOFA score was created to replace the original postoperative SOFA score with the perioperative changed values of bilirubin and creatinine. Performance of the adjusted SOFA score for predicting septic shock was comparable with the original SOFA score (AUC 0.987 vs. 0.985, p = 0.932). Under the premise of ensuring 100% sensitivity, the adjusted SOFA score reduced the 43.7% (31/71) false-positive rate for predicting septic shock compared with the original SOFA score. In conclusion, the gender should not be neglected when applying SOFA score for patients after PCNL. The adjusted SOFA score eliminates negative effects caused by gender differences in predicting septic shock.

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Acknowledgements

This work was sponsored by National Natural Science Foundation of China (81670642, Xiaofeng Gao), Shanghai Science and Technology Support Project in Biomedicine (17441900800, Yonghan Peng), and Shanghai Sailing Program (18YF1422600, Wei Zhang). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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  1. Rong Shen, Wei Zhang and Shaoxiong Ming contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Urology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China

    Rong Shen, Wei Zhang, Shaoxiong Ming, Ling Li, Yonghan Peng & Xiaofeng Gao

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Shen, R., Zhang, W., Ming, S. et al. Gender-related differences in the performance of sequential organ failure assessment (SOFA) to predict septic shock after percutaneous nephrolithotomy. Urolithiasis 49, 65–72 (2021). https://doi.org/10.1007/s00240-020-01190-x

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