Risk factors and outcomes of multiple episodes of peritoneal dialysis related bacterial peritonitis / 中华肾脏病杂志

ABSTRACT

Objective To investigate the risk factors and prognosis of peritoneal dialysis (PD)related bacterial peritonitis.Methods The clinical data of patients with PD related bacterial peritonitis from January 2006 to September 2016 in our hospital were retrospectively analyzed and followed up until December 2016.Patients were divided into two groups according to the frequency of peritonitis,single episode group and multiple episodes group (no less than two episodes of peritonitis).According to efficacy of therapy,the episodes of peritonitis were divided into two groups,cured group (no relapse,recurrence or repeat episodes) and failure group (relapse,recurrent or repeat infection after the therapy of initial episode).Logistic regression and Cox regression were used to analyze the risk factors for outcomes.Results Five hundred and fifty-nine patients had PD related bacterial peritonitis,including 339 patients in the single episode group and 220 patients in the multiple episodes group.Logistic analysis showed low serum albumin level (OR=787,P ＜ 0.001) and malnutrition (OR=0.422,P ＜ 0.001) at baseline were independent risk factors for multiple episodes (P ＜ 0.001).The technical survival was better in the single episode group than that in the multiple episodes group (75.2％ vs 36.2％,P=0.001) while the difference of survival rate was not significant between the two groups (48.2％ vs 24.1％,P=0.592).Five hundred and thirteen episodes of peritonitis were analyzed,including 147 episodes in failure group (88 relapse episodes,16 recurrent episodes and 43 repeat episodes) and 366 episodes in cured group.There were 78 patients in failure group and 253 patients in cured group.Logistic analysis showed prolonged response time (OR=1.200,P ＜ 0.001),Gram-positive bacteria infection (OR=1.736,P=0.022),higher hs-CRP level (OR=1.004,P=0.013),lower serum albumin level (OR=0.936,P=0.008) were independent risk factors for failure of therapy.Multivariate Cox regression showed prolonged response time (HR=1.120,P=0.032),Gram-positive bacteria infection (HR=2.462,P=0.002),higher hs-CRP level (HR=1.007,P=0.009) were independent risk factors for failure of therapy and higher serum albumin level (HR=0.942,P=0.048) was an independent protection factor.Conclusions Low serum albumin level and malnutrition at baseline are independent risk factors for patients with multiple peritonitis episodes.Prolonged response time,Gram-positive bacteria infection,the high hs-CRP level are independent risk factors for relapse or recurrent or repeat episodes while high serum albumin level was an independent protection factor.