Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China.
Division of Nephrology, Li Ka Shing Institute of Health Sciences, Hong Kong, China.
Kidney360. 2022 Mar 29;3(6):1031-1038. doi: 10.34067/KID.0000842022. eCollection 2022 Jun 30.
Distinguishing (TB) and nontuberculous (NTM) from bacterial peritoneal dialysis (PD)-related peritonitis (peritonitis) is often very challenging and can lead to a significant delay in diagnosis and treatment. The neutrophil-to-lymphocyte ratio (NLR) is readily calculable and has been shown to be useful in differentiating pulmonary TB from bacterial pneumonia. We are the first group to demonstrate the predictive efficacy of peritoneal dialysate (PDE) NLR in distinguishing TB/NTM peritonitis from bacterial causes in the PD population.
We retrospectively reviewed the clinical and laboratory characteristics of all patients with TB/NTM peritonitis, methicillin-sensitive (MSSA) peritonitis, and culture-negative peritonitis in our tertiary center between July 2000 and July 2020. The diagnostic ability of the blood and PDE NLR for differential diagnosis was evaluated.
In total, 258 episodes, 38 episodes, and 27 episodes were caused by MSSA, TB, and NTM species, respectively; 364 episodes were culture negative. The PDE NLR level taken at presentation were lowest in the TB peritonitis, followed by the NTM, culture-negative, and MSSA groups, (9.44±13.01, 16.99±23.96, 36.63±32.33, 48.51±36.01; <0.001, respectively). The area under the receiver operating characteristic curve for the NLR taken at presentation was 0.83 (95% confidence interval, 0.77 to 0.89; <0.001). A PDE NLR <15 was an optimal cut-off value with sensitivity, specificity, positive predictive value, and negative predictive values of 81%, 70%, 97%, and 22%, respectively.
The PDE NLR obtained at presentation is a useful and easily accessible marker to discriminate TB/NTM peritonitis from bacterial peritonitis, especially in areas with intermediate TB/NTM burden. The NLR may enable early prompting of TB/NTM peritonitis, allowing specific investigation and treatment to be instigated earlier.
区分结核分枝杆菌（TB）和非结核分枝杆菌（NTM）与细菌性腹膜透析（PD）相关腹膜炎（腹膜炎）通常非常具有挑战性，并可能导致诊断和治疗的显著延迟。中性粒细胞与淋巴细胞比值（NLR）易于计算，已被证明可用于区分肺结核和细菌性肺炎。我们是第一组证明腹膜透析液（PDE）NLR 在区分 PD 人群中 TB/NTM 腹膜炎与细菌性病因方面的预测功效的。
我们回顾性分析了 2000 年 7 月至 2020 年 7 月在我们的三级中心发生的 TB/NTM 腹膜炎、耐甲氧西林金黄色葡萄球菌（MSSA）腹膜炎和培养阴性腹膜炎患者的临床和实验室特征。评估了血液和 PDE NLR 对鉴别诊断的诊断能力。
总共 258 例、38 例和 27 例分别由 MSSA、TB 和 NTM 引起；364 例培养阴性。就诊时 PDE NLR 水平最低的是 TB 腹膜炎，其次是 NTM、培养阴性和 MSSA 组，（9.44±13.01、16.99±23.96、36.63±32.33、48.51±36.01；<0.001）。就诊时 NLR 的受试者工作特征曲线下面积为 0.83（95%置信区间，0.77 至 0.89；<0.001）。PDE NLR <15 是最佳截断值，具有 81%、70%、97%和 22%的敏感性、特异性、阳性预测值和阴性预测值。
就诊时获得的 PDE NLR 是区分 TB/NTM 腹膜炎与细菌性腹膜炎的有用且易于获得的标志物，尤其是在具有中等 TB/NTM 负担的地区。NLR 可能能够早期提示 TB/NTM 腹膜炎，从而更早地进行特定的调查和治疗。
