中国医学科学院学报2018，Vol.40Issue(1)：13-20,8.DOI:10.3881/j.issn.1000-503X.2018.01.003
腹膜透析相关性腹膜炎患者短期预后不良危险因素的分析
Predictors of Short-term Outcomes of Patients with Peritoneal Dialysis-associated Peritonitis
摘要
Abstract
Objective To investigate the risk factors predicting the short-term outcomes of patients with peritoneal dialysis (PD)-associated peritonitis (PDAP).Methods In this retrospective cohort study,the clinical data at baseline and 0-3 months before peritonitis onset (peritonitis-free period) were collected from endstage renal disease patients who started PD and suffered from PDAP between January 1,2004 and March 31,2017 in Peking Union Medical College Hospital.After 4 weeks of follow-up,these patients were divided into two groups according to the clinical outcomes,namely poor outcome group and good outcome group.Characteristics at baseline and before peritonitis were compared.Risk factors associated with short-term outcomes were also analyzed.Results Totally 162 PDAP patients were enrolled,among whom 55 (34.0％) experienced adverse outcomes and 107 (66.0％) had good outcome.At baseline,the proportion of clinical atherosclerotic vascular disease was significantly higher in poor outcome group than in good outcome group (49.1％ vs.31.8％;x2 =4.639,P =0.031),whereas indicators were comparable (all P ＞ 0.05).During the peritonitis-free period,significantly higher level of high-sensitivity C-reactive protein (hsCRP) [9.3 (2.2,16.3) mg/dl vs.3.6(1.4,9.5) mg/dl,Z =-2.879,P =0.004],higher proportion of low transport type of peritoneum function (8.7％ vs.1.0％;Z=4.879,P=0.027),and lower creatinine clearance rate [56.7 (45.7,71.1) ml/(min · w · 1.73 m2) vs.61.4 (54.5,76.4) ml/ (min · w · 1.73 m2);Z=-2.084,P=0.037] were observed in poor outcome group.Univariate Logistic regression analysis showed the combination of clinical atherosclerotic vascular disease (OR =2.070,95％ CI:1.062-4.034,P =0.033) and higher hsCRP before peritonitis (OR =1.032,95％ CI:1.001-1.059,P =0.015) were the risk factors of short-term poor outcome in PDAP patients.Multivariate Logistic regression analysis showed that,after the gender,age at peritonitis,PD duration,diabetes,and serum albumin before peritonitis were adjusted,higher hsCRP before peritonitis (OR =1.026,95％ CI:1.000-1.052,P =0.046) and comorbidity of clinical atherosclerotic vascular disease (OR =2.105,95％ CI:1.014-4.367,P =0.046) were the independent risk factors for the poor outcomes in PDAP patients.Conclusion Higher pre-peritonitis hsCRP and comorbidity of clinical atherosclerotic vascular disease at baseline may predict poor short-term outcomes in PDAP patients.关键词
腹膜透析/腹膜炎/超敏C反应蛋白/短期预后不良Key words
peritoneal dialysis/peritonitis/high-sensitivity C-reactive protein/short-term adverse outcome分类
医药卫生引用本文复制引用
马莹,王颖,王海云,李阳,周紫娟,刘炳岩,李雪梅,陈丽萌..腹膜透析相关性腹膜炎患者短期预后不良危险因素的分析[J].中国医学科学院学报,2018,40(1):13-20,8.基金项目
中国医学科学院医学与健康科技创新工程(2016-I2M-2-004)和中国医学科学院协和学者特聘教授基金 Supported by the CAMS Innovation Fund for Medical Science (CIFMS) (2016-I2M-2-004) and the CAMS Scholar Fund （2016-I2M-2-004）
