Murata G H, Fox L, Tzamaloukas A H
Ambulatory Care Service, Veterans Affairs Medical Center, Albuquerque.
Arch Intern Med. 1993 Oct 25;153(20):2317-21.
Peritonitis is a common problem for patients receiving continuous ambulatory peritoneal dialysis. Episodes that do not respond to antibiotics within 96 hours are associated with substantial morbidity and mortality. The purpose of this study was to develop a method for identifying these patients at the time of hospital admission.
We reviewed all cases of peritonitis associated with continuous ambulatory peritoneal dialysis that occurred at the Albuquerque (NM) Veterans Affairs Medical Center during a 10-year period. Episodes of peritonitis were randomly assigned to a training set or a validation set. Persistent infections were those lasting more than 96 hours. For training cases, stepwise logistic regression was used to develop a predictive model for persistent infection using information available at the time of hospital admission. The model was then used to assign validation cases to "high-" and "low-risk" categories. The group difference in the proportion of persistent cases was tested by chi 2 analysis.
Sixty patients had 120 episodes of peritonitis during the study period. Of 63 episodes assigned to the training set, 26 (41.3%) lasted more than 96 hours (persistent cases) and 37 were cured in 96 hours or less (usual cases). Compared with usual cases, persistent episodes were characterized by a higher age at presentation and a greater decline from preinfection values for hemoglobin and serum potassium, serum urea nitrogen, creatinine, albumin, and calcium. Advanced age and marked declines in serum potassium and albumin levels were identified by logistic regression as independent risk factors for persistent infection. The model identified 28 of 57 validation cases as high risk. Compared with low-risk cases, these episodes were much more likely to be persistent (64.3% vs 24.1%; P = .002) and result in death (32.1% vs 3.4%; P = .005).
Advanced age and marked declines in serum albumin and potassium levels are poor prognostic signs in peritonitis associated with continuous ambulatory peritoneal dialysis. Patients with these findings should be treated aggressively.
腹膜炎是接受持续性非卧床腹膜透析患者的常见问题。96小时内对抗生素无反应的发作与显著的发病率和死亡率相关。本研究的目的是开发一种在入院时识别这些患者的方法。
我们回顾了阿尔伯克基（新墨西哥州）退伍军人事务医疗中心在10年期间发生的所有与持续性非卧床腹膜透析相关的腹膜炎病例。腹膜炎发作被随机分配到训练集或验证集。持续性感染是指持续超过96小时的感染。对于训练病例，使用逐步逻辑回归，利用入院时可得的信息建立持续性感染的预测模型。然后使用该模型将验证病例分为“高风险”和“低风险”类别。通过卡方分析检验持续性病例比例的组间差异。
在研究期间，60名患者发生了120次腹膜炎发作。在分配到训练集的63次发作中，26次（41.3%）持续超过96小时（持续性病例），37次在96小时或更短时间内治愈（通常病例）。与通常病例相比，持续性发作的特点是就诊时年龄较大，血红蛋白、血清钾、血清尿素氮、肌酐、白蛋白和钙较感染前水平下降幅度更大。逻辑回归确定高龄以及血清钾和白蛋白水平显著下降是持续性感染的独立危险因素。该模型将验证集的57例病例中的28例识别为高风险。与低风险病例相比，这些发作更有可能是持续性的（64.3%对24.
