CONSTRUCTION OF SIRI NOMOGRAM FOR PREDICTING UROLITHIASIS RISK IN PATIENTS WITH METABOLIC SYNDROME AND TEMPORAL EXTERNAL VALIDATION OF ITS DEVELOPMENT
Keywords:
Metabolic syndrome, Urolithiasis, Systemic inflammation, Predictive modelAbstract
Objective: To explore the relationship between systemic inflammatory markers and urolithiasis, and to build a reliable nomogram to predict the risk of patients. Methods: A total of 878 patients were included in this study, and all of them were diagnosed with MetS and were admitted to the hospital between October 2022 and October 2025. All patients were divided into two groups, one with stones (n=246) and the other without stones (n=632). Logistic regression and LASSO regression were used to identify independent risk factors, and ROC curves, calibration plots, DCA and other methods were used to verify the effectiveness of the nomogram. In order to achieve temporal external validation, 111 patients were selected from other hospitals for analysis, and the study followed the TRIPOD statement. Results: Seven variables were identified as independent predictors: gender, age, urinary uric acid, urinary citrate, hs-CRP, IL-6, and the systemic inflammatory response index (SIRI). The nomogram demonstrated good discriminative capacity with an AUC of 0.751 (95% CI: 0.716–0.787) in the derivation cohort and 0.725 (95% CI: 0.617–0.833) in the validation cohort. The calibration intercept was 0.048, indicating excellent agreement between the predicted and observed risks. Decision curve analysis (DCA) confirmed a significant clinical net benefit. Conclusion: In the process of managing urolithiasis patients, the tool based on SIRI can play an important role, which is conducive to the implementation of personalized management and risk stratification.References
[1] Skolarikos A, Somani B, Neisius A, et al. Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: An EAU Guidelines Update. Eur Urol, 2024, 86(4): 343-363. DOI: 10.1016/j.eururo.2024.05.029.
[2] Samson S L, Garber A J. Metabolic syndrome. Endocrinol Metab Clin North Am, 2014, 43(1): 1-23. DOI: 10.1016/j.ecl.2013.09.009.
[3] Bargagli M, Scoglio M, Howles S A, et al. Kidney stone disease: risk factors, pathophysiology and management. Nat Rev Nephrol, 2025, 21(11): 794-808. DOI: 10.1038/s41581-025-00990-x.
[4] Khan S R. Reactive oxygen species, inflammation and calcium oxalate nephrolithiasis. Transl Androl Urol, 2014, 3(3): 256-276. DOI: 10.3978/j.issn.2223-4683.2014.06.04.
[5] Di X, Liu S, Xiang L, et al. Association between the systemic immune-inflammation index and kidney stone: A cross-sectional study of NHANES 2007-2018. Front Immunol, 2023, 14: 1116224. DOI: 10.3389/fimmu.2023.1116224.
[6] Qi Q, Zhuang L, Shen Y, et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer, 2016, 122(14): 2158-2167. DOI: 10.1002/cncr.30057.
[7] Zhang Z, Wang G, Dai X, et al. Association between the systemic inflammation response index and kidney stones in US adults: a cross-sectional study based on NHANES 2007-2018. Urolithiasis, 2024, 52(1): 165. DOI: 10.1007/s00240-024-01668-y.
[8] Tan S, Yuan D, Su H, et al. Prevalence of urolithiasis in China: a systematic review and meta-analysis. BJU Int, 2024, 133(1): 34-43. DOI: 10.1111/bju.16179.
[9] Ye Z, Wu C, Xiong Y, et al. Obesity, metabolic dysfunction, and risk of kidney stone disease: a national cross-sectional study. Aging Male Off J Int Soc Study Aging Male, 2023, 26(1): 2195932. DOI: 10.1080/13685538.2023.2195932.
[10] Weinberg A E, Patel C J, Chertow G M, et al. Diabetic severity and risk of kidney stone disease. Eur Urol, 2014, 65(1): 242-247. DOI: 10.1016/j.eururo.2013.03.026.
[11] Taguchi K, Okada A, Hamamoto S, et al. M1/M2-macrophage phenotypes regulate renal calcium oxalate crystal development. Sci Rep, 2016, 6: 35167. DOI: 10.1038/srep35167.
[12] Dominguez-Gutierrez P R, Kusmartsev S, Canales B K, et al. Calcium Oxalate Differentiates Human Monocytes Into Inflammatory M1 Macrophages. Front Immunol, 2018, 9: 1863. DOI: 10.3389/fimmu.2018.01863.
[13] Taguchi K, Hamamoto S, Okada A, et al. Genome-Wide Gene Expression Profiling of Randall’s Plaques in Calcium Oxalate Stone Formers. J Am Soc Nephrol JASN, 2017, 28(1): 333-347. DOI: 10.1681/ASN.2015111271.
[14] Verma S, Singh P, Khurana S, et al. Implications of oxidative stress in chronic kidney disease: a review on current concepts and therapies. Kidney Res Clin Pract, 2021, 40(2): 183-193. DOI: 10.23876/j.krcp.20.163.
[15] Asselman M, Verhulst A, De Broe M E, et al. Calcium oxalate crystal adherence to hyaluronan-, osteopontin-, and CD44-expressing injured/regenerating tubular epithelial cells in rat kidneys. J Am Soc Nephrol JASN, 2003, 14(12): 3155-3166. DOI: 10.1097/01.asn.0000099380.18995.f7.
[16] Dejban P, Wilson E M, Jayachandran M, et al. Inflammatory Cells in Nephrectomy Tissue from Patients without and with a History of Urinary Stone Disease. Clin J Am Soc Nephrol CJASN, 2022, 17(3): 414-422. DOI: 10.2215/CJN.11730921.
[17] Moe O W, Preisig P A. Dual role of citrate in mammalian urine. Curr Opin Nephrol Hypertens, 2006, 15(4): 419-424. DOI: 10.1097/01.mnh.0000232882.35469.72.
[18] Leslie S W, Bashir K. Hypocitraturia and Renal Calculi. In: StatPearls. StatPearls Publishing, 2026. http://www.ncbi.nlm.nih.gov/books/NBK564392/ (accessed March 18, 2026).
[19] Siener R, Glatz S, Nicolay C, et al. Prospective study on the efficacy of a selective treatment and risk factors for relapse in recurrent calcium oxalate stone patients. Eur Urol, 2003, 44(4): 467-474. DOI: 10.1016/s0302-2838(03)00317-8.
[20] Siener R, Hesse A. The effect of different diets on urine composition and the risk of calcium oxalate crystallisation in healthy subjects. Eur Urol, 2002, 42(3): 289-296. DOI: 10.1016/s0302-2838(02)00316-0.
[21] Siener R. Nutrition and Kidney Stone Disease. Nutrients, 2021, 13(6): 1917. DOI: 10.3390/nu13061917.
[22] Xu J Z, Li C, Xia Q D, et al. Sex disparities and the risk of urolithiasis: a large cross-sectional study. Ann Med, 2022, 54(1): 1627-1635. DOI: 10.1080/07853890.2022.2085882.
[23] Grundy S M. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol, 2008, 28(4): 629-636. DOI: 10.1161/ATVBAHA.107.151092.
[24] Tang Y, Zhang C, Mo C, et al. Predictive Model for Systemic Infection After Percutaneous Nephrolithotomy and Related Factors Analysis. Front Surg, 2021, 8: 696463. DOI: 10.3389/fsurg.2021.696463.
[25] Villanueva-Congote J, Hinojosa-Gonzalez D, Segall M, et al. The relationship between neutrophil/lymphocyte ratio, platelet/neutrophil ratio, and risk of urosepsis in patients who present with ureteral stones and suspected urinary tract infection. World J Urol, 2024, 42(1): 596. DOI: 10.1007/s00345-024-05229-1.