The Predictive Value Of Serum D-dimer Level On Treatment Failure Of Peritoneal Dialysis-associated Peritonitis

ObjectiveTo explore the incidence of treatment failure of peritoneal dialysis-related peritonitis(PDAP)in our center,and to investigate the predictive value of D-dimer for the treatment failure in the patient of peritoneal dialysis-associated peritonitis.MethodsThe clinical data of 201 patients with peritoneal dialysis-related peritonitis were analyzed retrospectively.they were divided into cure group and treatment failure group according to the treatment effect.The general data such as age,dialysis month,delay time and laboratory indexes such as plasma hypersensitive C-reactive protein(Hs-CRP),fibrinogen,D-dimer,serum albumin and serum creatinine were statistically compared between the two groups.Spearman correlation analysis was used to discuss the relationship between PDAP treatment failure and each index,and the relationship between D-dimer and each index.Binary Logistic regression was used to analyze the correlation strength between related indexes including D-dimer and PDAP treatment failure,the risk factors related to treatment failure were selected.And the predictive value of risk factors for treatment failure was analyzed by receiver operating characteristic curve(ROC).Results(1)Among 201 patients with PDAP,the incidence of treatment failure was 11.9%(177 patients in the treatment success group and 24 patients in the treatment failure group).Compared with the treatment failure group,the dialysis duration,the lag time of medical treatment,the constituent ratio of antibiotics used one week before admission,dialysate effluent white cell count on the third day,levels of hypersensitive C-reactive protein,fibrinogen and D-dimer in the successful treatment group were lower than those in the treatment failure group;and the serum albumin,the serum creatinine and the incidence of first peritonitis was higher.The difference was statistically significant(all P< 0.05).(2)The results of Spearman correlation analysis showed that the dialysis duration(r = 0.258,P < 0.001),the lag time of medical treatment(r = 0.177,P = 0.012),dialysate effluent white blood cell count on the third day(r = 0.297,P < 0.001),hypersensitive C-reactive protein(r = 0.194,P = 0.006),fibrinogen(r = 0.149,P = 0.035)and D-dimer(r = 0.312,P < 0.001)were positively correlated with the failure of PDAP treatment.Serum albumin and creatinine were negatively correlated with the failure of PDAP treatment.There was a positive correlation between D-dimer and age(r = 0.168,P =0.0017),the lag time of medical treatment(r = 0.184,P = 0.009),dialysate effluent white cell count on the third day(r = 0.168,P = 0.018),hypersensitive C-reactive protein(r = 0.163,P = 0.021),platelet count(r = 0.238,P = 0.001)and D-dimer.Serum albumin(r = 0.350,P < 0.001)was negatively correlated with D-dimer.(3)Univariate Logistic regression analysis suggested that long dialysis duration,high Hs-CRP,high D-dimer,low serum creatinine,long lag time of medical treatment,non-first peritonitis and pre-admission use of antibiotics were risk factors for failure of PDAP treatment(all P < 0.05).From the results of multivariate Logistic regression analysis,it was showed that long dialysis duration(OR=1.020,95% CI 1.001～1.038,P=0.037),high Hs-CRP(OR=1.007,95% CI 1.000～1.014,P=0.034),high D-dimer(OR=1.435,95% CI 1.068～1.929,P=0.017)and low serum creatinine(OR=0.997,95%CI 0.994～1.000,P=0.024)were independent risk factors for failure of PDAP treatment.(4)From the ROC curve,D-dimer had the best ability to predict PDAP treatment failure,.The AUC of dialysis duration,Hs-CRP,D-dimer and serum creatinine were0.730(95%CI 0.611～0.848,P < 0.001),0.673(95%CI 0.559～0.787,P = 0.006),0.778(95%CI 0.687,0.869,P < 0.001),0.351(95%CI 0.243～0.460,P = 0.018),respectively.Conclusions(1)The incidence of treatment failure in PD patients was 11.9%.(2)Patients with treatment failure of peritoneal dialysis-related peritonitis were characterized by long delay time to visit the hospital,taking antibiotics before admission,and non-first peritonitis attack.(3)The independent risk factors of treatment failure in patients with peritoneal dialysis-related peritonitis were dialysis months,high-sensitivity C-reactive protein,serum D-dimer and serum creatinine before treatment,and serum D-dimer had a greater predictive value for treatment failure.