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Predicting the Course of Peritonitis in Patients Receiving Continuous Ambulatory Peritoneal Dialysis

Predicting the Course of Peritonitis in Patients Receiving Continuous Ambulatory Peritoneal Dialysis Abstract Background: 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. Methods: 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 X2 analysis. Results: 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). Conclusions: 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.(Arch Intern Med. 1993;153:2317-2321) References 1. Vas SI. Peritonitis . In: Nolph KD, ed. Peritoneal Dialysis . 3rd ed. Dordrecht, the Netherlands: Kluwer Academic Publishers; 1989:261-288. 2. Fox L, Tzamaloukas AH, Murata GH. Metabolic differences between persistent and routine peritonitis in continuous ambulatory peritoneal dialysis (CAPD) . Adv Perit Dial. 1992;8:346-350. 3. Obermiller LE, Tzamaloukas AH, Leymon P, Avasthi PS. Intravenous vancomycin as initial treatment for gram-positive peritonitis in patients on chronic peritoneal dialysis . Clin Nephrol. 1985;24:256-260. 4. Wasson JH, Sox HC, Neff RK, Goldman L. Clinical prediction rules: applications and methodological standards . N Engl J Med. 1985;313:793-799.Crossref 5. Engelman L. Stepwise logistic regression . In: Dixon WJ, Brown MB, Engelman L, Jennrich RI, eds. BMDP Statistical Software Manual . Berkeley, Calif: University of California Press; 1990;2:1013-1046. 6. Glantz SA, Slinker BK. Primer of Applied Regression and Analysis of Variance . New York, NY: McGraw-Hill International Book Co; 1990:512-568. 7. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve . Radiology . 1982;143:29-36.Crossref 8. Lindblad AS, Novak JW, Nolph KD. Continuous Ambulatory Peritoneal Dialysis in the USA: Final Report of the National CAPD Registry 1981-1988 . Dordrecht, the Netherlands: Kluwer Academic Publishers; 1989:243-252. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Predicting the Course of Peritonitis in Patients Receiving Continuous Ambulatory Peritoneal Dialysis

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References (8)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1993.00410200031003
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: 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. Methods: 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 X2 analysis. Results: 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). Conclusions: 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.(Arch Intern Med. 1993;153:2317-2321) References 1. Vas SI. Peritonitis . In: Nolph KD, ed. Peritoneal Dialysis . 3rd ed. Dordrecht, the Netherlands: Kluwer Academic Publishers; 1989:261-288. 2. Fox L, Tzamaloukas AH, Murata GH. Metabolic differences between persistent and routine peritonitis in continuous ambulatory peritoneal dialysis (CAPD) . Adv Perit Dial. 1992;8:346-350. 3. Obermiller LE, Tzamaloukas AH, Leymon P, Avasthi PS. Intravenous vancomycin as initial treatment for gram-positive peritonitis in patients on chronic peritoneal dialysis . Clin Nephrol. 1985;24:256-260. 4. Wasson JH, Sox HC, Neff RK, Goldman L. Clinical prediction rules: applications and methodological standards . N Engl J Med. 1985;313:793-799.Crossref 5. Engelman L. Stepwise logistic regression . In: Dixon WJ, Brown MB, Engelman L, Jennrich RI, eds. BMDP Statistical Software Manual . Berkeley, Calif: University of California Press; 1990;2:1013-1046. 6. Glantz SA, Slinker BK. Primer of Applied Regression and Analysis of Variance . New York, NY: McGraw-Hill International Book Co; 1990:512-568. 7. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve . Radiology . 1982;143:29-36.Crossref 8. Lindblad AS, Novak JW, Nolph KD. Continuous Ambulatory Peritoneal Dialysis in the USA: Final Report of the National CAPD Registry 1981-1988 . Dordrecht, the Netherlands: Kluwer Academic Publishers; 1989:243-252.

Journal

Archives of Internal Medicine – American Medical Association

Published: Oct 25, 1993

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