Dong Xiao, Yi Chunyan, Ye Hongjian, Guo Jing, Liu Ruihua, Guo Qunying, Huang Fengxian, Yang Xiao
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, P.R. China.
Department of Nephrology, The First People's hospital of Foshan, Foshan, Guangdong, China.
Clin Kidney J. 2024 Oct 29;17(12):sfae332. doi: 10.1093/ckj/sfae332. eCollection 2024 Dec.
To prevent loss of peritoneal function caused by persistent abdominal inflammation, the guidelines recommend early extubation in patients with refractory peritoneal dialysis (PD)-associated peritonitis (rPDAP). In attempt to pinpoint high-risk patient cohorts that did not respond to treatment for refractory peritonitis, we created a model to predict the effectiveness of peritonitis treatment.
This observational cohort study included PD patients from 1 January 2011 to 31 December 2020. Multivariate logistic regression analysis was used to explore the factors affecting the occurrence and prognosis of rPDAP, and to construct a predictive model for the success of rPDAP treatment. Receiver operator characteristic curve, calibration and decision curve were drawn to evaluate the predictive performance of the model.
A total of 1397 cases of PDAP occurred in our center during the study period, of which 558 cases were diagnosed as rPDAP. The incidence of refractory peritonitis was 0.047 cases/patient-year. In the study, 440 cases with rPDAP were included. Among them, 304 cases (69.1%) had been successfully cured, while 136 cases (30.9%) were treatment failure, of which 19 cases (13.9%) died, 85 cases (62.5%) transferred to hemodialysis and 32 cases (23.5%) were relapse/recurrent peritonitis. Dialysate culture results showed 132 (30.0%) cases were infected with Gram-positive bacteria and 161 (36.6%) Gram-negative bacteria. Multivariate logistic regression analysis showed that episodes of peritonitis previously ≤3 times were correlated with the better prognosis of rPDAP, but white blood cell (WBC) counts in peritoneal dialysate on the third day of peritonitis or WBC counts on the fifth day ≥300 × 10/L, the pathogenic microorganism with Gram-negative bacteria, as well as longer duration of PD were associated with poor outcomes. The C-statistical value of the training data set was 0.870 (95% confidence interval 0.821-0.918). The calibration curve and clinical decision-making curve also proved that this nomogram could accurately predict the success of treatment in patients with refractory peritonitis.
The nomogram model created through internal verification indicated a strong clinical application value and a high prognostic prediction accuracy for rPDAP.
为防止持续性腹部炎症导致腹膜功能丧失，指南建议对难治性腹膜透析（PD）相关腹膜炎（rPDAP）患者尽早拔管。为了确定对难治性腹膜炎治疗无反应的高危患者群体，我们创建了一个模型来预测腹膜炎治疗的效果。
这项观察性队列研究纳入了2011年1月1日至2020年12月31日的PD患者。采用多因素logistic回归分析探讨影响rPDAP发生及预后的因素，并构建rPDAP治疗成功的预测模型。绘制受试者工作特征曲线、校准曲线和决策曲线以评估模型的预测性能。
研究期间，本中心共发生1397例PDAP，其中558例被诊断为rPDAP。难治性腹膜炎的发生率为0.047例/患者年。本研究纳入440例rPDAP患者。其中，304例（69.1%）成功治愈，136例（30.9%）治疗失败，其中19例（13.9%）死亡，85例（62.5%）转为血液透析，32例（23.5%）为复发/复发性腹膜炎。透析液培养结果显示，132例（30.0%）感染革兰氏阳性菌，161例（36.6%）感染革兰氏阴性菌。多因素logistic回归分析显示，既往腹膜炎发作次数≤3次与rPDAP预后较好相关，但腹膜炎第3天腹膜透析液白细胞（WBC）计数或第5天WBC计数≥300×10⁹/L、革兰氏阴性菌致病微生物以及PD病程较长与预后不良相关。训练数据集的C统计值为0.870（95%置信区间0.821 - 0.918）。校准曲线和临床决策曲线也证明，该列线图能够准确预测难治性腹膜炎患者的治疗成功情况。
通过内部验证创建的列线图模型对rPDAP具有较强的临床应用价值和较高的预后预测准确性。
