{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:55:21Z","timestamp":1793393721190,"version":"4.5.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"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. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the predictive value of preoperative inflammatory\u2013nutritional status and stone complexity for composite adverse outcomes following percutaneous nephrolithotomy (PCNL), and to develop a clinical risk stratification model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data of 386 patients with renal calculi who underwent PCNL at the Cangzhou Central Hospital between January 2021 and December 2024 were retrospectively analyzed. Composite adverse outcomes were defined as the occurrence of any of the following: postoperative fever (temperature &amp;gt;38\u202f\u00b0C), systemic inflammatory response syndrome (SIRS), requirement for blood transfusion, or complications of Clavien\u2013Dindo grade \u2265 II. Preoperative inflammatory\u2013nutritional status was assessed using the neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI), while stone complexity was quantified using the Guy\u2019s grading system and the S. T. O. N. E. nephrolithometry score. Multivariate logistic regression analysis was performed to identify independent risk factors, and a risk stratification model was constructed based on the number of these factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 386 patients, 121 (31.3%) experienced composite adverse outcomes postoperatively. Multivariate logistic regression analysis identified diabetes mellitus (OR\u202f=\u202f2.41, 95% CI: 1.32\u20134.41,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.004), preoperative urinary tract infection (OR\u202f=\u202f3.27, 95% CI: 1.58\u20136.78,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001), NLR\u202f\u2265\u202f3.5 (OR\u202f=\u202f2.18, 95% CI: 1.35\u20133.52,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001), PNI\u202f&amp;lt;\u202f45 (OR\u202f=\u202f2.03, 95% CI: 1.22\u20133.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.006), Guy\u2019s grade \u2265 III (OR\u202f=\u202f2.67, 95% CI: 1.56\u20134.56,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and S. T. O. N. E. score \u22658 (OR\u202f=\u202f3.14, 95% CI: 1.89\u20135.22,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) as independent risk factors for composite adverse outcomes after PCNL. Receiver operating characteristic (ROC) curve analysis indicated that \u22653 risk factors was the optimal cutoff for predicting composite adverse outcomes, with a sensitivity of 78.5%, specificity of 75.2%, and an area under the curve (AUC) of 0.837 (95% CI: 0.791\u20130.883). Patients were stratified into low-risk (0\u20132 factors), intermediate-risk (3\u20134 factors), and high-risk (\u22655 factors) groups, with corresponding incidence rates of composite adverse outcomes of 12.5, 34.6, and 68.4%, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative inflammatory\u2013nutritional status (NLR, PNI) and stone complexity (Guy\u2019s grading system, S. T. O. N. E. score) are independent predictors of composite adverse outcomes after PCNL. The risk stratification model based on the number of risk factors is simple and reliable, and can effectively identify high-risk patients, providing a basis for precise perioperative management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1867379","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:48:42Z","timestamp":1784695722000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk stratification of composite adverse outcomes after percutaneous nephrolithotomy based on preoperative inflammatory\u2013nutritional status and stone complexity: a single-center retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yu","family":"Qiu","sequence":"first","affiliation":[{"name":"Urologic Oncology Center, Cangzhou Central Hospital","place":["Cangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Decai","family":"Ji","sequence":"additional","affiliation":[{"name":"Urologic Oncology Center, Cangzhou Central Hospital","place":["Cangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guowang","family":"Du","sequence":"additional","affiliation":[{"name":"The No. 1 Department of Urology, Cangzhou People's Hospital","place":["Cangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.3892\/ijmm.2021.4982","article-title":"Recent advances on the mechanisms of kidney stone formation (review)","volume":"48","author":"Wang","year":"2021","journal-title":"Int J Mol Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1007\/s00345-022-04067-3","article-title":"Worldwide practice patterns of percutaneous nephrolithotomy","volume":"40","author":"Tailly","year":"2022","journal-title":"World J Urol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"110","DOI":"10.23736\/S2724-6051.20.04107-7","article-title":"Classification and Standardized Reporting of Percutaneous Nephrolithotomy (PCNL): International Alliance of Urolithiasis (IAU) consensus Statements","volume":"74","author":"Choong","year":"2022","journal-title":"Minerva Urol Nephrol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00240-022-01376-5","article-title":"The influencing factors of infectious complications after percutaneous nephrolithotomy: a systematic review and meta-analysis","volume":"51","author":"Zhou","year":"2022","journal-title":"Urolithiasis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s00240-024-01689-7","article-title":"Evaluating postoperative complications in standard percutaneous nephrolithotomy for renal stones larger than 2 cm: a retrospective study utilizing the E-PASS scoring system","volume":"53","author":"Gelmis","year":"2025","journal-title":"Urolithiasis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"6513","DOI":"10.2147\/IJGM.S497322","article-title":"The predictive value of systemic inflammatory biomarkers in predicting postoperative systemic inflammatory response syndrome after percutaneous nephrolithotomy","volume":"17","author":"Wei","year":"2024","journal-title":"Int J Gen Med"},{"key":"ref7","first-page":"222","article-title":"Predictive value of combined serum nuclear factor erythroid 2-related factor 2 and prognostic nutritional index for sepsis after percutaneous nephrolithotomy","volume-title":"Sage Journals","author":"Qi","year":"2025"},{"key":"ref8","first-page":"e82723","article-title":"Evaluation of the GUYS, STONE, and S-ReSC scores in predicting the outcomes of mini-percutaneous nephrolithotomy: a prospective study","volume-title":"Cureus","author":"Mushtaq","year":"2025"},{"key":"ref9","first-page":"e54790","article-title":"Comparison of STONE score, guy\u2019s stone score, CROES nomogram, and Seoul national university renal stone complexity score in prognosticating outcomes of multiple-tract mini-percutaneous nephrolithotomy: a retrospective study","volume-title":"Cureus","author":"Farooq","year":"2024"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.1016\/j.euf.2021.11.002","article-title":"Shockwave lithotripsy complications according to modified Clavien-Dindo grading system. 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