BACKGROUND: Effluent white cell count (WCC) is among the important prognostic factors for peritonitis outcome, but its trend has never been studied. We aimed to explore the clinical characteristics and outcomes of peritonitis episodes having different trends in effluent WCC change in the first 5 days. METHODS: For each peritonitis episode, we examined the patient's demographic and biochemical data, serial effluent WCC, and organisms cultured. Peritonitis-associated death and transfer to hemodialysis were defined as treatment failure. RESULTS: Based on the trend of effluent WCC in the first 5 days, we divided 190 peritonitis episodes into group A (WCC persistently declined), group B (WCC declined after a transient increase), group C (WCC increased after a transient decline), and group D (WCC persistently increased). In group A, peritonitis was caused mostly by gram-positive organisms, and effluent WCC declined the most quickly, leading to a good prognosis. Although the elevation of effluent WCC was prolonged in group B, and the infections were, compared with those in group A, more often caused by gram-negative organisms, outcomes were not worse. In group C, the effluent WCC was more likely to be higher than 100/μL on day 5, and the infection was, compared with those in groups A and B, less likely to be caused by gram-positive organisms. Accordingly, membership in group C independently predicted the worst outcome of peritonitis even adjusted for age, sex, and causative organism. CONCLUSIONS: Different trends of change in effluent WCC during the early stage of peritonitis represent different clinical patterns and outcomes. Further investigation for optimizing outcomes is required.
BACKGROUND: Effluent white cell count (WCC) is among the important prognostic factors for peritonitis outcome, but its trend has never been studied. We aimed to explore the clinical characteristics and outcomes of peritonitis episodes having different trends in effluent WCC change in the first 5 days. METHODS: For each peritonitis episode, we examined the patient's demographic and biochemical data, serial effluent WCC, and organisms cultured. Peritonitis-associated death and transfer to hemodialysis were defined as treatment failure. RESULTS: Based on the trend of effluent WCC in the first 5 days, we divided 190 peritonitis episodes into group A (WCC persistently declined), group B (WCC declined after a transient increase), group C (WCC increased after a transient decline), and group D (WCC persistently increased). In group A, peritonitis was caused mostly by gram-positive organisms, and effluent WCC declined the most quickly, leading to a good prognosis. Although the elevation of effluent WCC was prolonged in group B, and the infections were, compared with those in group A, more often caused by gram-negative organisms, outcomes were not worse. In group C, the effluent WCC was more likely to be higher than 100/μL on day 5, and the infection was, compared with those in groups A and B, less likely to be caused by gram-positive organisms. Accordingly, membership in group C independently predicted the worst outcome of peritonitis even adjusted for age, sex, and causative organism. CONCLUSIONS: Different trends of change in effluent WCC during the early stage of peritonitis represent different clinical patterns and outcomes. Further investigation for optimizing outcomes is required.
Authors: Philip Kam-Tao Li; Cheuk Chun Szeto; Beth Piraino; Judith Bernardini; Ana E Figueiredo; Amit Gupta; David W Johnson; Ed J Kuijper; Wai-Choong Lye; William Salzer; Franz Schaefer; Dirk G Struijk Journal: Perit Dial Int Date: 2010 Jul-Aug Impact factor: 1.756
Authors: Kai Ming Chow; Cheuk Chun Szeto; Kitty Kit-Ting Cheung; Chi Bon Leung; Sunny Sze-Ho Wong; Man Ching Law; Yiu Wing Ho; Philip Kam-Tao Li Journal: Clin J Am Soc Nephrol Date: 2006-05-31 Impact factor: 8.237
Authors: Murali Krishnan; Elias Thodis; Dimitrios Ikonomopoulos; Ed Vidgen; Maggie Chu; Joanne M Bargman; Stephen I Vas; Dimitrios G Oreopoulos Journal: Perit Dial Int Date: 2002 Sep-Oct Impact factor: 1.756