早期血小板计数高是腹膜透析相关性腹膜炎不良预后的独立危险因素

Early stage elevated platelet count is an independent risk factor for the poor prognosis of peritoneal dialysis-associated peritonitis

目的探讨早期血小板计数是否是腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)不良预后的独立影响因素。方法采用回顾性队列研究,选取2012年1月至2019年1月在佛山市第一人民医院因PDAP住院的所有患者,根据最终治疗结果将患者分为治愈组与退出组,其中退出组包括腹膜透析转血液透析以及死亡的患者,比较两组患者的基本人口学、血常规、透出液常规及生化指标,采用Logistic回归法分析患者退出的危险因素。结果共纳入180例患者,其中治愈组112例,退出组68例。与治愈组相比,退出组年龄更大[(53.38±14.17)岁比(48.41±13.04)岁,t=2.407,P=0.017],透析龄更长[(49.20±26.05)个月比(30.36±32.97)个月,t=4.034,P<0.001],住院治疗时间更长[(23.88±11.50)d比(17.80±3.95)d,t=5.133,P<0.001],血小板计数更高[(285.55±107.23)×10^9/L比(234.90±74.03)×10^9/L,t=3.450,P=0.001],血白蛋白更低[(31.72±7.47)g/L比(35.40±4.93)g/L,t=-3.972,P<0.001]。多因素Logistic回归分析结果显示,透析龄长(OR=1.012,95%CI 1.007~1.024,P=0.015)、血小板计数高(OR=1.013,95%CI 1.004~1.026,P=0.008)是患者退出腹膜透析的独立危险因素,而高白蛋白(OR=0.941,95%CI 0.896~0.988,P=0.005)是患者退出腹膜透析的保护因素。结论透析龄长、早期血小板计数高是PDAP患者退出腹膜透析的独立危险因素,而血白蛋白高是PDAP患者退出腹膜透析的保护因素。

Objective To determine whether the early stage platelet count can predict the outcome of peritoneal dialysis-associated peritonitis(PDAP).Methods A retrospective cohort study was conducted by selecting PDAP patients who were hospitalized in the First People's Hospital of Foshan from January 2012 to January 2019.According to the final treatment outcome,the patients were divided into cured group and withdrawn group.The withdrawn group included patients who transferred to hemodialysis or died.Basic data on demography,blood routine examination,peritoneal fluid,biochemical indicators were compared between the two groups.Logistic regression analysis was used to analyze the withdrawn risk factors of PDAP.Results There were 180 patients included in the study,including 112 cases in the cured group and 68 cases in the withdrawn group.Compared with the cured group,there were older age[(53.38±14.17)years old vs(48.41±13.04)years old,t=2.407,P=0.017],longer age of dialysis[(49.20±26.05)months vs(30.36±32.97)months,t=4.034,P<0.001],longer hospital stay[(23.88±11.50)d vs(17.80±3.95)d,t=5.133,P<0.001]and higher platelet count[(285.55±107.23)×10^9/L vs(234.90±74.03)×10^9/L,t=3.450,P=0.001],lower serum albumin[(31.72±7.47)g/L vs(35.40±4.93)g/L,t=-3.972,P<0.001]in the withdrawn group.Multivariate logistic regression analysis showed that longer dialysis age(OR=1.012,95%CI 1.007-1.024,P=0.015)and higher platelet count(OR=1.013,95%CI 1.004-1.026,P=0.008)were independent risk factors,and higher serum albumin(OR=0.941,95%CI 0.896-0.988,P=0.005)was an independent protective factor of withdrawal from peritoneal dialysis in PDAP patients.Conclusions The long dialysis age,early high platelet count are independent risk factors and high serum albumin level is an independent protective factor for withdrawal from peritoneal dialysis in PDAP patients.