Combined Predictive Value of Preoperative Serum TLR4/NF-κB and Urinary Leukocyte Esterase for Postoperative Urinary Tract Infection After Flexible Ureteroscopic Holmium Laser Lithotripsy
ZENG Xiaofu
FU Guangqing
HUANG Fengming
HAN Dengjun
Abstract：Objective To explore the combined predictive value of preoperative serum Toll-like receptor 4(TLR4)/nuclear factor-kappa B(NF-κB)and urinary leukocyte esterase(ULE)for urinary tract infection(UTI)after flexible uretero-scopic holmium laser lithotripsy(F-URS).Methods A prospective study was conducted on 300 patients with upper urinary tract calculi admitted to Zigong Fourth People's Hospital from January 2023 to May 2024.All patients underwent F-URS.Ac-cording to the occurrence of postoperative UTI,patients were divided into the infection group(46 cases)and the non-infec-tion group(254 cases).Baseline data,preoperative serum levels of TLR4 and NF-κB,and positive rate of ULE were com-pared between the two groups.Pearson correlation coefficient was used to analyze the correlations between preoperative se-rum TLR4,NF-κB,ULE and conventional inflammatory indicators[white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT)].Logistic regression analysis was performed to explore the relationship between preoperative serum TLR4,NF-κB,ULE and postoperative UTI.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of preoperative serum TLR4,NF-κB,ULE and conventional inflammatory indicators for postoperative UTI.Results The infection group had higher age,higher proportion of previous stone surgery history,and higher preoperative levels of WBC,CRP and PCT than the non-infection group(all P<0.05).Preoperative se-rum levels of TLR4 and NF-κB in the infection group were higher than those in the non-infection group,and positive rate of ULE were lower than those in the non-infection group(all P<0.05).Patients with positive ULE had higher preoperative se-rum levels of TLR4 and NF-κB than those with negative ULE(all P<0.05).Logistic regression analysis showed that age,previous stone surgery history,preoperative serum TLR4,NF-κB and ULE were independent influencing factors for postop-erative UTI after F-URS(all P<0.05).After adjusting for age and previous stone surgery history,preoperative serum TLR4,NF-κB and ULE remained independent influencing factors for postoperative UTI after F-URS(all P<0.05).ROC curve anal-ysis showed that the AUCs of preoperative serum TLR4,NF-κB and ULE for predicting postoperative UTI after F-URS were 0.778,0.763 and 0.751,respectively,which were slightly higher than those of conventional inflammatory indicators WBC,CRP and PCT(0.726,0.735 and 0.725).Subsequently,a combined prediction model of preoperative serum TLR4,NF-κB and ULE was constructed.The AUC of the combined prediction of preoperative serum TLR4,NF-κB and ULE for postopera-tive UTI after F-URS was 0.921,which was significantly higher than the predictive value of each indicator alone(Z=3.621,3.805,4.033,all P<0.001).Conclusion Preoperative serum TLR4/NF-κB combined with ULE can reliably predict the risk of UTI after F-URS,which can help clinicians take scientific prevention and treatment measures.
Keywords：flexible ureteroscopic holmium laser lithotripsyurinary tract infectiontoll-like receptor 4nuclear fac-tor-kappa burinary leukocyte esterasepredictive value
Publication Date：2025-10-28
Online Publishing Date：2026-01-15(First online date of this platform, not the publication date of the document)
Pages：6( 321-326 )