A clinical prediction score to predict refractory peritonitis in peritoneal dialysis patients
Keywords:
Peritoneal Dialysis, peritonitis, end stage renal disease, refractory, clinical prediction ruleAbstract
Background and Objective: Peritoneal dialysis related peritonitis is the major complication in peritoneal dialysis patients. After 5 days of proper treatment, leukocytes in the dialysate are still more than 100 cells/ mm3 is called refractory peritonitis. No clinical tools have been made to predict refractory peritonitis. This study aimed to develop the clinical prediction score to predict refractory peritonitis in peritoneal dialysis patients.
Method: This study was retrospective cohort study in peritoneal dialysis patients who were diagnosed with peritonitis from July 2016 to December 2017 in Udon Thani Hospital. Multivariate logistic regression analysis was used to develop the clinical prediction factors and transformed into scores by logistic coefficients and created an associated risk score and total risk score.
Results: 395 episodes of peritonitis were included in analysis; 78 episodes (19.8%) were refractory peritonitis. The prognostic factors that include in score were malnutrition, abdominal pain on the 3rd day of treatment, diarrhea on the 3rd day of treatment, still cloudy effluent on the 3rd day of treatment, white blood cells in dialysate on the 3rd day of treatment ≥ 1,000 cells/mm3, white blood cells in dialysate on the 3rd day of treatment ≥ 50% of white blood cells in dialysate on the 1st day of treatment. The prediction score had good performance to predict refractory peritonitis with an AuROC of 0.95 (95% CI 0.92-0.97). The Likelihood ratio of positive was 0.02 in the low-risk category, 1.5 in the moderate-risk category and 19.3 in the high-risk category.
Conclusion: A clinical prediction score to predict refractory peritonitis may help the clinician to monitor and care in peritoneal dialysis patients with peritonitis.
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