Establishing A New Index Predicting Mortality In Peritoneal Dialysis Patients From Conventional Indexes

ObjectivesAs the population of end-stage kidney disease continues to expand,there are more and more end stage renal disease patients choosing peritoneal dialysis as their renal replacement therapy.The prognostic factors of peritoneal dialysis patients have attracted more and more attentions,there are many researches on prognosis combining index in peritoneal dialysis patients,for example neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR).These new indixes can assess peritoneal dialysis patient's prognosis.We aim to establish a new combining index which can be used to assess the continuous ambulatory peritoneal dialysis patients prognosis through retrospective cohort study.In our study,this new index is cholesterol/(albumin ^ 2)*1000.(TC/(Alb^2)*1000)SubjectsOur study enrolled 498 CAPD patients aged? 18 years who received catherization for peritoneal dialysis during January 1,2007 to March 1,2018 in hospital.They were followed up to March 1,2019,or reached the end point,such as all-cause death or transfer to hemodialysis(HD),or kidney transplantation.MethodIn this study,retrospective study was used to collect the basic information of patients and clinical laboratory data.The statistical software sas9.4 was used.Multiple imputation method is used to fill in the missing data if variables with less missing data.And variables with more missing data are discarded.First of all,according to the ending.patients were divided into death group and survival group,and continuous variables with significant differences between the two groups were screened out.Put the selected variables into Cox model,and select the two significant laboratory indicators for prognosis.According to the exploration and comparison of indicator combination,a new indicator TC/(ALB ^ 2)× 1000 is established.In ROC analysis,TC/(ALB ^ 2)× 1000 is better than single index in predicting prognosis.Then we verify the relationship between the new indicators and all-cause death.According to the cut-off value of the new indicators,patients were divided into high value group and low value group.Using Kaplan Meier survival curve to analyse,and there is a significant difference in the survival curve between the two groups;Cox risk model is used for multivariate analysis to evaluate the relationship between the new indicators and all-cause deathResults1.After preliminary screening,and through the screening of multiple combinations,the new combination index is TC/(ALB ^ 2)*1000.2.The area under ROC curve(AUC)of TC/(ALB ^ 2)*1000 is significantly higher than that of a single blood index(0.69).3.According to the later verification,using Kaplan Meier survival curve and Cox regression model for analysis,the results showed that there were significant differences in survival curves between the two groups.Cox risk regression analysis showed that alkaline phosphatase,platelet count and TC/(ALB ^ 2)× 1000 were risk factors of all-cause death in CAPD patients through multivariate analysis.4.Bivariate correlation analysis showed that TC/(ALB ^ 2)× 1000,alkaline phosphatase and platelet count were correlated with some inflammatory indexes.Conclusion1.The new index cholesterol/(albumin ^ 2)*1000 is a new combination index that can predict all-cause death of peritoneal dialysis patients,and its predictive effect on the outcome is higher than that of clinical single index.It is related to inflammation indexes.2.The higher level of alkaline phosphatase or platelet count is a risk factor of all-cause death in peritoneal dialysis patients,which is related to inflammation indexes.