Rigo Mariane, Pecoits-Filho Roberto, Lambie Mark, Tuon Felipe Francisco, Barretti Pasqual, de Moraes Thyago Proença
School of Medicine, 28100Pontifical Catholic University of Paraná(PUCPR), Curitiba, Brazil.
School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, UK.
Perit Dial Int. 2021 May;41(3):292-297. doi: 10.1177/0896860820949032. Epub 2020 Aug 28.
Exit-site infection (ESI) is an important risk factor for peritonitis in patients under chronic peritoneal dialysis (PD). The International Society for Peritoneal Dialysis (ISPD) recommend its diagnosis as the presence of purulent drainage in the exit site (ES) but time-consuming scores using others skin signs are routinely used.
To investigate the correlation between the diagnosis of ESI with a score based on five clinical signs obtained from ES inspection, and also if there are interaction with patient's race.
Multicenter and prospective cohort. We included adult patients from 122 clinics, incident on PD and with a 12-month stay in therapy. The event of interest was ESI, defined as purulent drainage. The clinical score used was composed of hyperemia, edema, pain, scab, and granuloma. Statistical analysis was performed using multilevel logistic regression model, likelihood test, and Cohen concordance analysis.
A total of 35,354 ES assessments were performed during the first year of dialysis in 3297 patients. There was a rate of 10.1 (9.1-11.2) episodes of ESI per 1000 patients/month. In patients with ESI, the prevalence of hyperemia was 55.9%, edema 67.3%, pain 31.8%, and scab 23.2%. The agreement with the score was 60.6% and showed differences according to the patient's race, being 53.2% for African Americans descendants and 65.4% for others. The use of scales for the diagnosis of ESI does not add much information in addition to the presence of purulent secretion as currently recommended by the ISPD.
出口处感染（ESI）是慢性腹膜透析（PD）患者发生腹膜炎的重要危险因素。国际腹膜透析学会（ISPD）建议将出口处有脓性引流作为其诊断标准，但目前仍常规使用基于其他皮肤体征的耗时评分。
研究基于出口处检查获得的五项临床体征的评分与ESI诊断之间的相关性，以及是否与患者种族存在交互作用。
多中心前瞻性队列研究。我们纳入了来自122个诊所的成年患者，这些患者开始进行PD治疗且治疗时间为12个月。感兴趣的事件为ESI，定义为脓性引流。所使用的临床评分为充血、水肿、疼痛、结痂和肉芽肿。使用多水平逻辑回归模型、似然比检验和科恩一致性分析进行统计分析。
在3297例患者透析的第一年共进行了35354次出口处评估。每1000患者/月的ESI发生率为10.1（9.1 - 11.2）次。在发生ESI的患者中，充血的患病率为55.9%，水肿为67.3%，疼痛为31.8%，结痂为23.2%。与该评分的一致性为60.6%，且根据患者种族存在差异，非裔美国人后裔为53.2%，其他种族为65.4%。除了ISPD目前推荐的脓性分泌物外，使用ESI诊断量表并没有增加太多信息。
