Mehrazma Mitra, Amini-Alavijeh Zahra, Hooman Nakysa
Department of Pathology, Ali-Asghar Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Kidney Dis. 2012 Mar;6(2):114-8.
Early prediction of the efficacy of treatment in peritonitis complicating peritoneal dialysis (PD) is the best way to reduce morbidity. We studied the prognostic value of the third-day dialysis effluent leukocyte count after antibiotic therapy for prediction of treatment outcomes.
Medical records of 31 children on PD, younger than 15 years old, admitted in Ali-Asghar Children's Hospital because of PD-related peritonitis, were reviewed retrospectively. Peritonitis was defined by fever, abdominal pain, and cloudy effluent with a leukocyte count greater than 100/mm3 or a positive dialysis effluent culture for microorganisms. For each episode of peritonitis, the leukocyte count of the effluent was measured on the third day after initiation of empiric therapy and culture results were recorded. The receiver operating characteristic curve was used to perform predicting value assessments.
Of 60 episodes of peritonitis, 68.3% were treated successfully. Of the remaining episodes, 15.8% resulted in mortality, 57.9% required catheter removal, and 26.3% led to both. The mean PD effluent leukocyte count on the third day after initiating empiric antibiotics was significantly higher in the group with treatment failure (2258 ± 796/mm3) than in the group with successful treatment (1325 ± 669/mm3; P < .001). The cutoff point of 1240/mm3 was found with optimized sensitivity (100%), specificity (63.4%), positive predictive value (55.9%), and negative predictive value (100%) for prediction of treatment failure (P < .001).
This study showed that the third-day dialysis effluent leukocyte count predicted short outcomes of peritonitis.
早期预测腹膜炎合并腹膜透析（PD）治疗效果是降低发病率的最佳方法。我们研究了抗生素治疗后第三天透析液白细胞计数对预测治疗结果的预后价值。
回顾性分析了阿里 - 阿斯加尔儿童医院收治的31例15岁以下因PD相关腹膜炎接受治疗的儿童的病历。腹膜炎定义为发热、腹痛、透析液浑浊且白细胞计数大于100/mm³或透析液微生物培养阳性。对于每例腹膜炎发作，在经验性治疗开始后第三天测量透析液白细胞计数，并记录培养结果。采用受试者工作特征曲线进行预测价值评估。
在60例腹膜炎发作中，68.3%治疗成功。其余发作中，15.8%导致死亡，57.9%需要拔除导管，26.3%两者皆有。经验性使用抗生素后第三天，治疗失败组的平均PD透析液白细胞计数（2258±796/mm³）显著高于治疗成功组（1325±669/mm³；P<.001）。发现预测治疗失败的截断点为1240/mm³，其敏感性（100%）、特异性（63.4%）、阳性预测值（55.9%）和阴性预测值（100%）最佳（P<.001）。
本研究表明，第三天透析液白细胞计数可预测腹膜炎的短期治疗结果。
