Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Perit Dial Int. 2012 Jan-Feb;32(1):29-36. doi: 10.3747/pdi.2010.00300. Epub 2011 Jun 30.
Little is known regarding the causes and outcomes of peritoneal dialysis (PD) patients admitted to the intensive care unit (ICU). We explored the outcomes of technique failure and mortality in a cohort of PD patients admitted to the ICU.
Using a provincial database of 990 incident PD patients followed from January 1997 to June 2009, we identified 90 (9%) who were admitted to the ICU. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics. The Cox proportional hazards and competing risk methods were used to investigate associations.
Compared with other patients, those admitted to the ICU had been on PD longer (p < 0.0001) and were more often on continuous ambulatory PD (74.2% vs 25.8%, p = 0.016). Cardiac problems were the most common admitting diagnosis (50%), followed by sepsis (23%), with peritonitis accounting for 69% of the sepsis admissions. The 1-year mortality was 53.3%, with 12% alive and converted to hemodialysis, and one third remaining alive on PD. In multivariate Cox modeling, age [hazard ratio (HR): 1.01; 95% confidence interval (CI): 0.99 to 1.03], white blood cell count (HR: 1.02; 95% CI: 1.00 to 1.04), temperature (HR: 0.75; 95% CI: 0.61 to 0.92), and peritonitis (1.64; 95% CI: 1.21 to 2.22) at admission to the ICU were associated with the composite outcome of technique failure or death. In a competing risk analysis, the risk for death was 30%, and for technique failure, 36% at 1 year.
Patients on PD have high rates of death and technique failure after admission to the ICU.
对于因腹膜透析（PD）而住进重症监护病房（ICU）的患者，人们对其发病原因和转归知之甚少。我们研究了住进 ICU 的 PD 患者技术失败和死亡的结局。
利用 1997 年 1 月至 2009 年 6 月间一个覆盖 990 例 PD 患者的省级数据库，我们发现有 90 例（9%）住进了 ICU。采用参数和非参数检验来确定基线特征的差异。采用 Cox 比例风险和竞争风险方法来研究相关性。
与其他患者相比，住进 ICU 的患者接受 PD 治疗的时间更长（p < 0.0001），而且更常接受持续非卧床 PD（74.2%比 25.8%，p = 0.016）。心脏问题是最常见的入住诊断（50%），其次是败血症（23%），其中 69%的败血症入住患者发生腹膜炎。1 年死亡率为 53.3%，12%的患者存活并转为血液透析，三分之一的患者仍存活且继续接受 PD 治疗。在多变量 Cox 模型中，年龄[风险比（HR）：1.01；95%置信区间（CI）：0.99 至 1.03]、白细胞计数（HR：1.02；95%CI：1.00 至 1.04）、体温（HR：0.75；95%CI：0.61 至 0.92）和入住 ICU 时的腹膜炎（HR：1.64；95%CI：1.21 至 2.22）与技术失败或死亡的复合结局相关。在竞争风险分析中，死亡风险为 30%，技术失败风险为 1 年时的 36%。
PD 患者住进 ICU 后死亡率和技术失败率较高。
