{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:03:39Z","timestamp":1784203419335,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative sepsis is a serious complication of flexible ureteroscopy (FURS). Body mass index (BMI) may modify risk, but BMI-stratified prediction models are lacking. We developed and internally validated BMI-specific nomograms for early SIRS-defined sepsis after FURS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective cohort included 1,254 adults undergoing FURS (2020\u20132024), stratified by BMI (&amp;lt;25 vs.\u202f\u2265\u202f25\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Multivariable logistic regression identified independent predictors of SIRS-defined sepsis within 48\u202fh in each stratum. BMI-specific nomograms were constructed and internally validated using 1,000 bootstrap resamples.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SIRS-defined sepsis occurred in 78\/1,254 (6.2%): 42\/504 (8.3%) with BMI\u202f\u2265\u202f25 vs. 36\/750 (4.8%) with BMI\u202f&amp;lt;\u202f25 (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.011). In both strata, positive urine culture, staghorn stones, CRP\u202f\u2265\u202f10\u202fmg\/L, and procalcitonin \u22650.5\u202fng\/mL were independent risk factors. Operative time \u226560\u202fmin was significant only in the BMI\u202f\u2265\u202f25 group, while postoperative albumin \u226535\u202fg\/L was protective only in the BMI\u202f&amp;lt;\u202f25 group. The BMI\u202f\u2265\u202f25 nomogram showed excellent discrimination (AUC 0.94, optimism-corrected 0.92), and the BMI\u202f&amp;lt;\u202f25 nomogram performed robustly (AUC 0.90, optimism-corrected 0.88), with good calibration and net benefit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BMI-stratified nomograms identified shared and BMI-specific risk factors for early SIRS-defined sepsis after FURS. These tools may aid individualized perioperative risk assessment, pending external validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1855137","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:10:20Z","timestamp":1784200220000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["BMI-stratified nomograms to predict early SIRS-defined sepsis after flexible ureteroscopy"],"prefix":"10.3389","volume":"13","author":[{"given":"Qing-Hua","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Urology, Nanchang People\u2019s Hospital","place":["Nanchang, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da-Qing","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Fifth People\u2019s Hospital of Ganzhou","place":["Ganzhou, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Tao","family":"Tan","sequence":"additional","affiliation":[{"name":"Jiangxi Province Key Laboratory of Breast Diseases, Nanchang People\u2019s Hospital","place":["Nanchang, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei-Hua","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Urology, Nanchang People\u2019s Hospital","place":["Nanchang, Jiangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1186\/s40001-025-02754-6","article-title":"Development and external validation of a nomogram for predicting sepsis following flexible ureteroscopy","volume":"30","author":"Liu","year":"2025","journal-title":"Eur J Med Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1111\/bju.16029","article-title":"Sepsis prevalence and associated hospital admission and mortality after ureteroscopy in employed adults","volume":"132","author":"Bhojani","year":"2023","journal-title":"BJU Int"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/iwj.70068","article-title":"Risk factors for surgical site infections after orthopaedic surgery: a meta-analysis and systematic review","volume":"22","author":"Liu","year":"2025","journal-title":"Int Wound J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1038\/s41366-021-01035-6","article-title":"Obesity and infectious diseases: pathophysiology and epidemiology of a double pandemic condition","volume":"46","author":"Pugliese","year":"2022","journal-title":"Int J Obes"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/s11934-020-0969-2","article-title":"Predictors of urinary infections and urosepsis after ureteroscopy for stone disease: a systematic review from EAU section of Urolithiasis (EULIS)","volume":"21","author":"Chugh","year":"2020","journal-title":"Curr Urol Rep"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1016\/j.jtcvs.2011.07.033","article-title":"The impact of low preoperative fat-free body mass on infections and length of stay after cardiac surgery: a prospective cohort study","volume":"142","author":"van Venrooij","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/s13167-021-00251-4","article-title":"Caution, \"normal\" BMI: health risks associated with potentially masked individual underweight-EPMA position paper 2021","volume":"12","author":"Golubnitschaja","year":"2021","journal-title":"EPMA J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"228","DOI":"10.21037\/tau-22-34","article-title":"Development and validation of a novel nomogram for predicting systemic inflammatory response syndrome's occurrence in patients undertaking flexible ureteroscopy","volume":"11","author":"Xuan","year":"2022","journal-title":"Transl Androl Urol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"814293","DOI":"10.3389\/fsurg.2022.814293","article-title":"A novel nomogram for predicting post-operative Sepsis for patients with solitary, unilateral and proximal ureteral stones after treatment using percutaneous Nephrolithotomy or flexible ureteroscopy","volume":"9","author":"Sun","year":"2022","journal-title":"Front Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1378\/chest.101.6.1644","article-title":"Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. 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