Chang Cheng-Chih, Liu Cheng-Chi, Hsieh Ching-Chuan, Tsai David Ming Then, Lin Shih-Jiun, Lin Da-Wei, Shih Ya-Hsueh, Hsu Yung-Chien, Lin Chun-Liang
Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Department of Nephrology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan.
Updates Surg. 2025 May 25. doi: 10.1007/s13304-025-02256-4.
Peritonitis is a debilitating complication of peritoneal dialysis (PD). Identifying high-risk patients requiring PD catheter removal based on early information in the emergency room (ER) is critical. This cross-sectional study included 518 PD patients who visited the ER in the Chang Gung Memorial Hospital, Chia-Yi branch between 2002 and 2018. Among the 518 PD patients, 31 (6%) required PD catheter removed during the visit. Decision tree analysis, incorporating five key factors (neutrophil count, CRP, age, sodium, and albumin), identified 16 terminal nodes (TNs), with four higher risk groups (> 20%): lower neutrophils with lower CRP and younger age (TN1), lower neutrophils with higher CRP (TN4), higher neutrophils with moderate age and lower albumin (TN14), and high neutrophils with older age (TN16). Decision tree analysis effectively predicts the optimal timing for catheter removal in PD peritonitis patients. Clinically, this approach helps reduce mortality resulting from delayed catheter removal.
腹膜炎是腹膜透析（PD）的一种严重并发症。根据急诊室（ER）的早期信息识别需要拔除PD导管的高危患者至关重要。这项横断面研究纳入了2002年至2018年间在嘉义长庚纪念医院急诊室就诊的518例PD患者。在这518例PD患者中，有31例（6%）在就诊期间需要拔除PD导管。决策树分析纳入了五个关键因素（中性粒细胞计数、CRP、年龄、钠和白蛋白），识别出16个终末节点（TNs），其中有四个高危组（>20%）：中性粒细胞较低、CRP较低且年龄较小（TN1），中性粒细胞较低、CRP较高（TN4），中性粒细胞较高、年龄中等且白蛋白较低（TN14），以及中性粒细胞较高且年龄较大（TN16）。决策树分析有效地预测了PD腹膜炎患者拔除导管的最佳时机。临床上，这种方法有助于降低因延迟拔除导管导致的死亡率。
