Abstract:

Objective Platelet-to-lymphocyte ratio (PLR) is a biomarker for the prognosis of many diseases. Currently, there are no studies on patients with recurrent peritoneal dialysis-associated peritonitis (RPDAP, definedas ≥2 peritoneal dialysis-associated peritonitis [PDAP] episodes within 1 year). This study aims to explore the predictive value of the PLR for RPDAP. Methods This single-center, retrospective cross-sectional study reviewed patients diagnosed with PDAP at the First Hospital of Hebei Medical University from January 2017 to December 2022. Patients were categorized by PDAP frequency during follow-up into the idiopathic peritoneal dialysis-associated peritonitis group (IPDAP group; one PDAP episode within 1 year) and RPDAP group. Demographic and laboratory data were collected. Associations between PLR and RPDAP were assessed by univariate logistic regression, and the predictive performance of baseline PLR for RPDAP was evaluated using receiver operating characteristic (ROC) curve analysis. Results A total of 83 PDAP patients were included: 56 in the IPDAP group and 27 in the RPDAP group. Compared with the IPDAP group, the RPDAP group had lower body mass index (BMI) and longer dialysis vintage (both P<0.05). The main causes of PDAP were improper technique and enteric infections. The proportion of drug-resistant organisms was higher in the RPDAP group (P<0.05). Treatment effective rate in the RPDAP group was 40.71%, significantly lower than 82.14% in the IPDAP group (P<0.05). Treatment failure requiring catheter removal occurred in 44.44% of RPDAP patients, significantly higher than 14.28% in the IPDAP group (P<0.05). There was no significant difference in mortality between the two groups (P>0.05). Compared with the IPDAP group, the RPDAP group had higher PLR and lower hemoglobin and albumin levels (all P<0.05). Univariate logistic regression identified lower BMI, longer dialysis vintage, higher PLR, and lower hemoglobin and albumin as factors associated with RPDAP (all P<0.05). The ROC curve for baseline PLR predicting RPDAP yielded an area under the curve (AUC) of 0.611 (95%CI: 0.560-0.662, P<0.05). The optimal PLR cutoff was 165.1, with specificity 79.8% and sensitivity 68.2%. Conclusion PLR has modest predictive value for RPDAP and may serve as a potential predictive biomarker for RPDAP in peritoneal dialysis patients.

Key words: peritoneal dialysis, peritoneal dialysis-associated peritonitis, frequent, platelet-to-lymphocyte ratio