Pecoits-Filho Roberto, Yabumoto Franciele M, Campos Ludimila G, Moraes Thyago P, Figueiredo Ana E, Olandoski Márcia, Shimakura Silvia E, Barretti Pasqual
Pontifical Catholic University of Parana, Curitiba, Brazil.
Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
Nephrology (Carlton). 2018 Mar;23(3):253-258. doi: 10.1111/nep.12986.
Since the impact of peritonitis on long-term non-infectious mortality has not been investigated until the present, the aim of this study was to analyze the impact of peritonitis on long-term cardiovascular (CV) mortality in a large peritoneal dialysis (PD) cohort.
The analysis was based on BRAZPD II, a national prospective cohort study that recruited patients in Brazilian centres from December 2004 to January 2011. Incident adult PD patients with at least 90 days on treatment were included in the analysis. Cardiovascular death occurring after a minimum of 30 days after a peritonitis episode was considered the primary endpoint. Cox regression analysis for time-dependent variables was used for the adjustments.
There were 2405 episodes of peritonitis in 5707 patients (48% males, 44% diabetes, 73% hypertensive). Patients with one episode of peritonitis presented a 22% increase in the hazard ratio of late CV mortality compared to those who never experienced peritonitis (HR1.22; CI95%1.01-1.47). Adjusted hazard for CV mortality showed a stepwise negative effect on survival for each additional peritonitis episode of infection: two episodes (HR1.78; CI95%1.31-2.42), three episodes (HR2.81; CI95%1.83-4.32) and four episodes (HR3.84; CI95%2.01-7.32).
Peritonitis was an independent predictor of CV mortality and the frequency of peritonitis was strongly associated with an increase in this risk. This is the first study to demonstrate the impact of peritonitis on late cardiovascular mortality of PD patients, suggesting a link between acute inflammation and cardiovascular outcomes.
由于目前尚未对腹膜炎对长期非感染性死亡率的影响进行研究，本研究旨在分析腹膜炎对大型腹膜透析（PD）队列中患者长期心血管（CV）死亡率的影响。
该分析基于BRAZPD II，这是一项全国性前瞻性队列研究，于2004年12月至2011年1月在巴西各中心招募患者。纳入分析的是治疗时间至少为90天的成年新发PD患者。腹膜炎发作至少30天后发生的心血管死亡被视为主要终点。对时间依赖性变量进行Cox回归分析以进行调整。
5707例患者中发生了2405次腹膜炎发作（男性48%，糖尿病患者44%，高血压患者73%）。与从未经历过腹膜炎的患者相比，发生过一次腹膜炎的患者晚期CV死亡率的风险比增加了22%（风险比1.22；95%置信区间1.01 - 1.47）。CV死亡率的调整后风险显示，每增加一次腹膜炎感染发作，对生存有逐步的负面影响：两次发作（风险比1.78；95%置信区间1.31 - 2.42），三次发作（风险比2.81；95%置信区间1.83 - 4.32）和四次发作（风险比3.84；95%置信区间2.01 - 7.32）。
腹膜炎是CV死亡率的独立预测因素，腹膜炎的发作频率与该风险的增加密切相关。这是第一项证明腹膜炎对PD患者晚期心血管死亡率影响的研究，提示急性炎症与心血管结局之间存在联系。
