{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:27:06Z","timestamp":1784129226916,"version":"3.55.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"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. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Flexible ureteroscopy lithotripsy (FURL) is a prevalent intervention for the management of upper urinary tract stones (UUTS). Assessing the onset of systemic inflammatory response syndrome (SIRS) in patients during and postoperatively is a critical determinant in the decision-making process regarding the necessity of preoperative ureteral stenting prior to FURL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>A total of 340 patients with UUTS who underwent one-stage FURL were analyzed retrospectively. Least absolute shrinkage and selection operator and multivariate logistic regression analysis were used to screen out independent risk factors, subsequently developing a nomogram. The predictive performance was internally assessed using the concordance index (C-index), receiver operating characteristic curve, and calibration curve. Additionally, we evaluated the risk of SIRS in the context of one-stage FURL, considering the impact of various available variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Age, urinary white blood cells, urine bacterial culture, and systemic immune-inflammation index (SII) were integrated to establish a nomogram for prediction of the risk of SIRS in patients undergoing one-stage FURL. The SII exhibited the highest odds ratio (OR\u2009=\u200930.356) for SIRS. The nomogram demonstrated a favorable predictive performance with a C-index of 0.964 (95% CI\u2009=\u20090.932\u20130.996), an area under the curve of 0.935, and a calibration curve validating its accuracy. We further developed a scoring system and classified the risk of SIRS into four grades.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The developed nomogram and risk scoring system demonstrate favorable predictive ability and clinical serviceability for the personalized estimation of SIRS risk in UUTS patients undergoing one-stage FURL. It is advisable to place a ureteral stent prior to FURL in individuals with an SII exceeding 1,300 and meeting one of the following criteria: age\u2009&amp;gt;\u200960 years, urinary white blood cell levels of 1+\/2+\/3+, or positive urine bacterial culture. The insights provided may assist clinicians in selecting safer therapeutic approaches for UUTS patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1592507","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T05:30:40Z","timestamp":1746768640000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Nomogram and scoring system for preoperative prediction of the risk of systemic inflammatory response syndrome in one-stage flexible ureteroscopy lithotripsy"],"prefix":"10.3389","volume":"12","author":[{"given":"Yuan","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rentao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinman","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengquan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changming","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1007\/s00345-020-03240-w","article-title":"Preoperative urine nitrite versus urine culture for predicting postoperative fever following flexible ureteroscopic lithotripsy: a propensity score matching analysis","volume":"39","author":"Ma","year":"2021","journal-title":"World J Urol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1089\/end.2020.1002","article-title":"Systemic inflammatory response syndrome combined with pre- and postoperative white blood cell ratio is a better criterion to identify septic shock patients after flexible ureteroscopic lithotripsy","volume":"35","author":"Ma","year":"2021","journal-title":"J Endourol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1111\/bju.13250","article-title":"Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) global study","volume":"117","author":"Assimos","year":"2016","journal-title":"BJU Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1007\/s00240-024-01607-x","article-title":"Application of 11\/13Fr suctioning ureteral access sheath and 8.55Fr single-use digital flexible ureteroscope in one-stage flexible ureteroscopic lithotripsy: an initial experience of 900 cases","volume":"52","author":"Huang","year":"2024","journal-title":"Urolithiasis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1080\/0886022X.2021.1872625","article-title":"The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1\u20133\u2005cm renal stones and risk factors of renal function changes","volume":"43","author":"Pan","year":"2021","journal-title":"Ren Fail"},{"key":"B6","doi-asserted-by":"publisher","first-page":"6842479","DOI":"10.1155\/2020\/6842479","article-title":"Risk factors for systemic inflammatory response syndrome induced by flexible ureteroscope combined with holmium laser lithotripsy","volume":"2020","author":"Mi","year":"2020","journal-title":"Biomed Res Int"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1393734","DOI":"10.3389\/fmed.2024.1393734","article-title":"Influence of preoperative urine culture and bacterial species on urogenital sepsis after ureteral flexible lithotripsy in patients with upper urinary tract stones","volume":"11","author":"Wang","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"B8","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1016\/S1473-3099(12)70239-6","article-title":"Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study","volume":"12","author":"Levy","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1227031","DOI":"10.3389\/fmed.2023.1227031","article-title":"Dissecting contributions of individual systemic inflammatory response syndrome criteria from a prospective algorithm to the prediction and diagnosis of sepsis in a polytrauma cohort","volume":"31","author":"Schefzik","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1164187","DOI":"10.3389\/fimmu.2023.1164187","article-title":"The role of mtDAMPs in the trauma-induced systemic inflammatory response syndrome","volume":"18","author":"Ye","year":"2023","journal-title":"Front Immunol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1142346","DOI":"10.3389\/fmed.2023.1227031","article-title":"Progress in the study of biomarkers for early prediction of systemic inflammatory response syndrome after percutaneous nephrolithotomy","volume":"30","author":"Wu","year":"2023","journal-title":"Front Immunol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/s13049-017-0399-4","article-title":"Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality\u2014a prospective study of patients admitted with infection to the emergency department","volume":"25","author":"Askim","year":"2017","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1089\/end.2021.0185","article-title":"Enhanced antibiotic treatment based on positive urine dipstick infection test before percutaneous nephrolithotomy did not prevent postoperative infection in patients with negative urine culture","volume":"35","author":"Xu","year":"2021","journal-title":"J Endourol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2026","DOI":"10.3390\/jpm12122026","article-title":"The predictive value of systemic immune-inflammation index and symptom severity score for sepsis and systemic inflammatory response syndrome in odontogenic infections","volume":"12","author":"Pricop","year":"2022","journal-title":"J Pers Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1542","DOI":"10.3390\/cancers16081542","article-title":"The prognostic value of the systemic immune-inflammation index (SII) and red cell distribution width (RDW) in patients with cervical cancer treated using radiotherapy","volume":"16","author":"Staniewska","year":"2024","journal-title":"Cancers (Basel)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1071465","DOI":"10.3389\/fendo.2022.1071465","article-title":"Systemic immune-inflammation index is associated with diabetic kidney disease in type 2 diabetes mellitus patients: evidence from NHANES 2011\u20132018","volume":"6","author":"Guo","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"4575","DOI":"10.2147\/JIR.S463163","article-title":"The systemic immune-inflammation index as an independent predictor of survival in patients with locally advanced esophageal squamous cell carcinoma undergoing neoadjuvant radiotherapy","volume":"11","author":"Zhang","year":"2024","journal-title":"J Inflamm Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.2106\/JBJS.23.01360","article-title":"Preoperative laboratory values predicting periprosthetic joint infection in morbidly obese patients undergoing total hip or knee arthroplasty","volume":"106","author":"Telang","year":"2024","journal-title":"J Bone Joint Surg Am"},{"key":"B20","doi-asserted-by":"publisher","first-page":"4941","DOI":"10.2147\/JIR.S461277","article-title":"Usefulness of the systemic inflammation response Index and the systemic immune inflammation index in predicting restenosis after stent implantation","volume":"23","author":"Xu","year":"2024","journal-title":"J Inflamm Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1186\/s12890-024-03086-7","article-title":"Predictive significance of systemic immune-inflammation index combined with prealbumin for postoperative pneumonia following lung resection surgery","volume":"24","author":"Miao","year":"2024","journal-title":"BMC Pulm Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"935","DOI":"10.2147\/IJGM.S451466","article-title":"The clinical value of systemic immune inflammation index (SII) in predicting the severity of hospitalized children with Mycoplasma Pneumoniae pneumonia: a retrospective study","volume":"17","author":"Wang","year":"2024","journal-title":"Int J Gen Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1007\/s00240-021-01266-2","article-title":"Significance of preoperative systemic immune-inflammation (SII) in predicting postoperative systemic inflammatory response syndrome after percutaneous nephrolithotomy","volume":"49","author":"Peng","year":"2021","journal-title":"Urolithiasis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1111\/bju.14484","article-title":"Early and rapid prediction of postoperative infections following percutaneous nephrolithotomy in patients with complex kidney stones","volume":"123","author":"Chen","year":"2019","journal-title":"BJU Int"},{"key":"B25","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1016\/j.juro.2014.03.004","article-title":"Infectious outcomes of nephrostomy drainage before percutaneous nephrolithotomy compared with concurrent access","volume":"192","author":"Benson","year":"2014","journal-title":"J Urol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1016\/j.ajog.2023.06.035","article-title":"Fetal growth restriction and small for gestational age as predictors of neonatal morbidity: which growth nomogram to use?","volume":"229","author":"Leon","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2600","DOI":"10.1002\/cam4.5137","article-title":"Nomograms and scoring system for forecasting overall and cancer-specific survival of patients with prostate cancer","volume":"12","author":"Zhou","year":"2023","journal-title":"Cancer Med"},{"key":"B28","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":"15","author":"Sun","year":"2022","journal-title":"Front Surg"},{"key":"B29","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\u2019s occurrence in patients undertaking flexible ureteroscopy","volume":"11","author":"Xuan","year":"2022","journal-title":"Transl Androl Urol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2711","DOI":"10.1007\/s40520-023-02545-1","article-title":"Does age impact outcomes of retrograde intrarenal surgery in the elderly? Results from 366 patients from the FLEXible ureteroscopy outcomes registry (FLEXOR)","volume":"35","author":"Giulioni","year":"2023","journal-title":"Aging Clin Exp Res"},{"key":"B31","doi-asserted-by":"publisher","first-page":"4983","DOI":"10.1038\/s41467-022-32636-y","article-title":"Diabetes downregulates the antimicrobial peptide psoriasin and increases E. coli burden in the urinary bladder","volume":"13","author":"Mohanty","year":"2022","journal-title":"Nat Commun"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1592507\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T05:30:41Z","timestamp":1746768641000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1592507\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,9]]},"references-count":31,"alternative-id":["10.3389\/fsurg.2025.1592507"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1592507","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,9]]},"article-number":"1592507"}}