Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan.
Singapore Med J. 2020 Nov;61(11):605-612. doi: 10.11622/smedj.2019106. Epub 2019 Sep 6.
Nontraumatic acute abdomen (NTAA) in dialysis patients is a challenging issue. The aetiologies of NTAA vary considerably depending on the renal replacement therapy (RRT) modality. Although haematological parameters and contributing factors have been reported to be associated with outcomes for dialysis patients, their clinical effect on the length of hospital stay (LOS) remains unknown.
We retrospectively analysed 52 dialysis patients (peritoneal dialysis [PD], n = 33; haemodialysis [HD], n = 19) and 30 non-dialysis patients (as controls) between January 2011 and December 2014. To attenuate the selection bias, non-dialysis patients with NTAA were matched to cases at a ratio of 1:1 by age, gender and comorbidities (diabetes mellitus and hypertension). Their demographic characteristics, laboratory data, clinical assessment scores and LOS were analysed.
The PD group exhibited a significantly higher neutrophil percentage, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR); longer LOS; and lower lymphocyte percentage and absolute lymphocyte count than the control group. After multivariate analysis adjustment, female gender, longer RRT duration and higher intact parathyroid hormone (iPTH) levels were associated with a lower probability of being discharged home. In the dialysis group, a higher iPTH level (> 313 μg/mL) was positively correlated with longer LOS. iPTH level combined with NLR can be used as a surrogate marker for predicting longer LOS (p < 0.001).
NTAA dialysis patients with female gender, longer RRT duration and higher iPTH levels are prone to experiencing longer LOS. In addition, the combination of iPTH and NLR is a significant determinant for LOS in NTAA dialysis patients.
透析患者的非创伤性急性腹痛（NTAA）是一个具有挑战性的问题。NTAA 的病因因肾脏替代治疗（RRT）方式而有很大差异。尽管已有研究报道血液学参数和促成因素与透析患者的预后相关，但它们对住院时间（LOS）的临床影响尚不清楚。
我们回顾性分析了 2011 年 1 月至 2014 年 12 月期间的 52 例透析患者（腹膜透析[PD]，n=33；血液透析[HD]，n=19）和 30 例非透析患者（作为对照组）。为了减轻选择偏倚，非透析 NTAA 患者按年龄、性别和合并症（糖尿病和高血压）与病例 1:1 匹配。分析了他们的人口统计学特征、实验室数据、临床评估评分和 LOS。
PD 组的中性粒细胞百分比、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）显著较高；LOS 较长；淋巴细胞百分比和绝对淋巴细胞计数较低。经多变量分析调整后，女性、RRT 持续时间较长和较高的全段甲状旁腺激素（iPTH）水平与较低的出院回家概率相关。在透析组中，较高的 iPTH 水平（>313μg/mL）与较长的 LOS 呈正相关。iPTH 水平与 NLR 联合可用作预测 LOS 较长的替代标志物（p<0.001）。
女性、RRT 持续时间较长和 iPTH 水平较高的 NTAA 透析患者易出现较长的 LOS。此外，iPTH 和 NLR 的组合是 NTAA 透析患者 LOS 的重要决定因素。
