Development and Validation of a Prediction Model for the Cure of Peritoneal Dialysis-Associated Peritonitis: A Multicenter Observational Study

Abstract

AimPeritoneal dialysis (PD)-associated peritonitis (PDAP) is a severe complication of PD. It is an important issue about whether it can be cured. At present, there is no available prediction model for peritonitis cure. Therefore, this study aimed to develop and validate a prediction model for peritonitis cure in patients with PDAP.MethodsPatients with PD who developed PDAP from four dialysis centers in Northeast China were followed up. According to the region of PD, data were divided into training and validation datasets. Initially, a nomogram for peritonitis cure was established based on the training dataset. Later, the nomogram performance was assessed by discrimination (C-statistic), calibration, and decision curves.ResultsTotally, 1,011 episodes of peritonitis were included in the final analysis containing 765 in the training dataset and 246 in the validation dataset. During the follow-up period, peritonitis cure was reported in 615 cases from the training dataset and 198 from the validation dataset. Predictors incorporated in the final nomogram included PD duration, serum albumin, antibiotics prior to admission, white cell count in peritoneal dialysate on day 5 (/μl) ≥ 100/μl, and type of causative organisms. The C-statistic values were 0.756 (95% CI: 0.713–0.799) in the training dataset and 0.756 (95% CI: 0.681–0.831) in the validation dataset. The nomogram exhibited favorable performance in terms of calibration in both the training and validation datasets.ConclusionThis study develops a practical and convenient nomogram for the prediction of peritonitis cure in patients with PDAP, which assists in clinical decision-making.

Survival Analysis and Associated Factors of Technique Failure in Peritoneal Dialysis-Related Peritonitis: A Single-Center Study

“…One such study reported that higher ALB levels indicated a higher probability of peritonitis recovery 22 ; however, other studies do not support ALB as a predictor 9 , such as ours.…”

Technique failure in peritoneal dialysis-related peritonitis: risk factors and patient survival

“…Another study reported that higher albumin levels indicated a higher probability of peritonitis recovery [ 36 ]. However, our study did not support this conclusion.…”

Peritoneal Dialysis–Related Infections

“…Outcomes in treating PD-related peritonitis depend on center-level and patient-level characteristics. 56 At the center level, larger center size (higher proportion of dialysis patients treated with PD) and higher center adherence to treatment guidelines are associated with higher peritonitis cure rate. 7 At the individual level, treatment outcomes are closely related to organism type and virulence, treatment timeliness, and peritonitis etiology.…”

“…The recommendation to have early antibiotic therapy is based on three observational studies. [56][57][58] In an Australian study, longer contact-to-treatment time was independently associated with a higher risk of treatment failure, defined as either PD catheter removal or death at 30 days. Each hour of delay in antibiotic treatment was associated with a higher risk of treatment failure by 5.5%.…”

“…58 Finally, a third study confirmed that antibiotic administration before hospitalization was an independent predictor of peritonitis cure. 56 Taken together, patients should be educated to contact their PD centers immediately if peritonitis is suspected. In case of patient presentation to the emergency department or other centers that are not familiar with PD, it may be more prudent to initiate immediate intravenous antibiotics.…”