Construction of the clinical prediction model of rebleeding after super-selective renal artery embolization after renal bleeding treated with PCNL

Objective To investigate the influencing factors of rebleeding after super-selective renal artery embolization(SRAE) in renal bleeding patients treated with percutaneous nephrolithotomy(PCNL).

Methods The clinical data of 80 post-PCNL renal hemorrhage patients treated with SRAE were retrospectively analyzed, and the cases were divided into the rebleeding group(9 cases) and control group(71 cases) according to whether they had rebleeding after SRAE.The univariate and multivariate logistic analysis were used to analyze the factors affecting rebleeding after SRAE, and the risk prediction model was established.The effectiveness of the prediction model was verified by receiver operating characteristic(ROC) curve.

Results Among 80 patients with postoperative renal bleeding after PCNL, one time SRAE in 71 patients(88.8%) were successful, and the second embolization for hemostasis in 9 patients(11.2%) were successful after the first SRAE treatment.The results of univariate analysis showed that the PCNL multiple puncture channels, multiple bleeding foci, white blood cell count before SRAE, neutrophil count before SRAE were correlated with rebleeding after SRAE(P < 0.05 to P < 0.01).The results of multivariate logistic regression analysis showed that preoperative blood NEU(OR=2.873, P < 0.05) and multiple bleeding lesions(OR=5.969, P < 0.05) were the independent predictors of postoperative rebleeding after SRAE.The combination of the above two factors was used to construct the prediction model, and the effect of the prediction model were good(χ²=5.28, P>0.05).The area under ROC curve was 0.806(95%CI: 0.688-0.924), and the sensitivity and specificity were 88.9% and 67.6%, respectively.

Conclusions Multiple bleeding sites and blood NEU before SRAE are the risk factors of rebleeding after SRAE after PCNL, and the risk prediction model constructed based on these factors has certain clinical applicability.The infection should be actively controlled after PCNL rebleeding, all suspected bleeding points should be comprehensively identified and embolization during SRAE, which can reduce the risk of rebleeding after SRAE.