van Esch Sadie, Krediet Raymond T, Struijk Dirk G
Contrib Nephrol. 2012;178:264-270. doi: 10.1159/000337889. Epub 2012 May 25.
Despite advances in treatment and prevention, peritonitis remains a major problem in peritoneal dialysis (PD) patients with often technique failure as a consequence. The last decades the focus of PD peritonitis has changed from lowering peritonitis incidence to improvement of peritonitis outcome. Prognostic factors for peritonitis outcome can influence decision making during the treatment of peritonitis, for example to take out the PD catheter early in the time course of peritonitis and prevent further damage to the peritoneal membrane. In this paper, we give a review of the literature about prognostic factors for peritonitis outcome. In most studies, age, gender, diabetes, time on PD, a precursor of calcitonin:procalcitonin, IL-6 and albumin did not show a significant effect on peritonitis outcome. The following factors have been associated with poor outcome of peritonitis: Gram-negative organisms, Mycobacterium species, fungal peritonitis, polymicrobial peritonitis, concurrent exit site or tunnel infection, Caucasian race, low residual GFR, persistently elevated peritoneal dialysate white cell count, CRP, and low levels of slCAM-1 and hyaluronan at the end of peritonitis treatment. In fungal peritonitis, abdominal pain, bowel obstruction, the catheter remaining in situ and Candidaparapsilosis are factors associated with higher mortality rate and a greater risk of technique failure. Recent antibiotic therapy and peritonitis are associated with poor treatment response in culture-negative peritonitis. Recurrent peritonitis episodes have a poor therapeutic response and high mortality and have a worse prognosis than relapsing ones. Older age, long PD duration and continuous elevated serum CRP levels are predictors of adverse outcomes in PD patients after peritonitis-related catheter removal. Peritonitis remains a serious complication of PD with marked morbidity. It is a common cause of technique failure. The rate of PD-related peritonitis has decreased over the last decades due to advances in treatment and prevention. Nowadays, the focus moved from lowering peritonitis incidence towards improving peritonitis outcome. It is useful to have prognostic factors for peritonitis outcome, because they can influence decision-making during the treatment of peritonitis, for example to take out the PD catheter early in the time course of peritonitis and prevent further damage to the peritoneal membrane. In the last decades, many publications appeared about prognostic factors for peritonitis outcome. This article summarizes those prognostic factors, based on an extensive review of the literature.
尽管在治疗和预防方面取得了进展，但腹膜炎仍是腹膜透析（PD）患者的一个主要问题，常常导致技术失败。在过去几十年里，PD腹膜炎的重点已从降低腹膜炎发病率转向改善腹膜炎的治疗结果。腹膜炎治疗结果的预后因素会影响腹膜炎治疗期间的决策，例如在腹膜炎病程早期拔除PD导管，防止对腹膜造成进一步损害。在本文中，我们对有关腹膜炎治疗结果预后因素的文献进行了综述。在大多数研究中，年龄、性别、糖尿病、PD治疗时间、降钙素原前体、白细胞介素-6和白蛋白对腹膜炎治疗结果未显示出显著影响。以下因素与腹膜炎不良治疗结果相关：革兰氏阴性菌、分枝杆菌属、真菌性腹膜炎、多种微生物引起的腹膜炎、同时存在的出口处或隧道感染、白种人、残余肾小球滤过率低、腹膜透析液白细胞计数持续升高、C反应蛋白（CRP）以及在腹膜炎治疗结束时可溶性细胞间黏附分子-1（sICAM-1）和透明质酸水平低。在真菌性腹膜炎中，腹痛、肠梗阻、导管留置原位以及近平滑念珠菌是与较高死亡率和更大技术失败风险相关的因素。近期抗生素治疗与培养阴性腹膜炎的治疗反应不佳有关。复发性腹膜炎发作治疗反应差、死亡率高，且预后比复发型更差。年龄较大、PD治疗时间长以及血清CRP水平持续升高是PD患者在因腹膜炎相关原因拔除导管后的不良预后预测因素。腹膜炎仍然是PD的一种严重并发症，发病率很高。它是技术失败的常见原因。由于治疗和预防方面的进展，过去几十年里与PD相关的腹膜炎发生率有所下降。如今，重点已从降低腹膜炎发病率转向改善腹膜炎治疗结果。了解腹膜炎治疗结果的预后因素很有用，因为它们会影响腹膜炎治疗期间的决策，例如在腹膜炎病程早期拔除PD导管，防止对腹膜造成进一步损害。在过去几十年里，出现了许多关于腹膜炎治疗结果预后因素的出版物。本文在广泛综述文献的基础上总结了这些预后因素。
