Prognostic factors and impact of peritoneal dialysis-related early peritonitis on mortality in Sardjito General Hospital, Yogyakarta, Indonesia

Metalia Puspitasari, H. Prasanto, I. Kuswadi
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Abstract

Background Peritonitis has been reported to be asso­ciated with high mortality. However, information on the impact of the first peritonitis episode on continu­ous ambulatory peritoneal dialysis (CAPD) patients is sparse. ObjectiveTo determine the association between peritoneal dialysis-related early peritonitis and mor­tality. To determine prognostic factors on mortality in peritonitis patients with peritoneal dialysis. Methods A retrospective observational cohort study was conducted over 5 years at a single PD unit in Sardjito Hospital. Inclusion criteria: First onset of peritonitis patients with peritoneal dialysis from 2013 -2017, age ≥ 18 years old. Exclusion criteria: Incomplete medical records. A total of 48 patients on CAPD with peritonitis was divided into the early onset of peritonitis (< 20 months) and late onset of peritonitis ( ≥ 20 months. Kaplan-Meier survival curve was used to display cumulative relative risk as a parameter of prognostic factors. Results A total of 48 patients (early onset of peritonitis, n = 31; late onset of peritonitis, n = 17) were analyzed in our study with a mean of age50.6 years consisted of males 64.6%. There was a significant difference in patients’ mortality between the early and late onset of peritoni­tis. The Kaplan-Meier analysis revealed that log-rank test, p<0.05 with a mean survival time of patients with early peritonitis and late peritonitis was 236 days (95% CI: 162-309 days) and 1702 days (95% CI: 1067-2338 days) consecutively. Compared to those who were nor­moweight, underweight or overweight patients had in­creased risk of mortality, (RR 1.14 and 1.15; p=0.003, respectively). There was a significant association be­tween diabetes mellitus and lower serum creatinine levels, and the risk of mortality (RR 1.43, p=0.03 and mean difference -6.01, p< 0.001, respectively). Conclusions Early peritonitis patients have a poor prognosis compared to the late peritonitis group. Pa­tients with shorter time to first peritonitis were prone to having a higher mortality rate. Diabetes mellitus, under­weight or overweight, and lower serum creatinine are prognostic factors of mortality in peritonitis patients.
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预后因素和腹膜透析相关的早期腹膜炎对死亡率的影响在Sardjito总医院,日惹,印度尼西亚
背景:据报道,腹膜炎与高死亡率有关。然而,关于首次腹膜炎发作对持续动态腹膜透析(CAPD)患者的影响的信息很少。目的探讨腹膜透析相关性早期腹膜炎与死亡率的关系。目的:探讨腹膜透析后腹膜炎患者死亡率的影响因素。方法回顾性观察队列研究在Sardjito医院单个PD科室进行了超过5年的研究。纳入标准:2013 -2017年首次发生腹膜透析的腹膜炎患者,年龄≥18岁。排除标准:医疗记录不完整。将48例CAPD合并腹膜炎患者分为早发性腹膜炎(< 20个月)和晚发性腹膜炎(≥20个月)。Kaplan-Meier生存曲线显示累积相对危险度作为预后因素的参数。结果48例患者(早发性腹膜炎31例;我们的研究分析了迟发性腹膜炎,n = 17),平均年龄50.6岁,男性占64.6%。早发性和晚发性腹膜炎患者的死亡率有显著差异。Kaplan-Meier分析显示,log-rank检验,p<0.05,早期和晚期腹膜炎患者的平均生存时间分别为236天(95% CI: 162 ~ 309天)和1702天(95% CI: 1067 ~ 2338天)。与体重正常的患者相比,体重过轻或超重患者的死亡风险增加,(RR分别为1.14和1.15;分别为p = 0.003)。糖尿病与低血清肌酐水平及死亡风险之间存在显著相关性(RR为1.43,p=0.03,平均差值为-6.01,p< 0.001)。结论早期腹膜炎患者预后较晚期腹膜炎患者差。发生首次腹膜炎时间越短,死亡率越高。糖尿病、体重过轻或超重、血清肌酐降低是腹膜炎患者死亡的预后因素。
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