Prognostic value of dialysis effluent leukocyte count in children on peritoneal dialysis with peritonitis

Early prediction of the efficacy of treatment in peritonitis complicating peritoneal dialysis (PD) is the best way to reduce morbidity. We studied the prognostic value of the third-day dialysis effluent leukocyte count after antibiotic therapy for prediction of treatment outcomes.

Medical records of 31 children on PD, younger than 15 years old, admitted in Ali-Asghar Children's Hospital because of PD-related peritonitis, were reviewed retrospectively. Peritonitis was defined by fever, abdominal pain, and cloudy effluent with a leukocyte count greater than 100/mm3 or a positive dialysis effluent culture for microorganisms. For each episode of peritonitis, the leukocyte count of the effluent was measured on the third day after initiation of empiric therapy and culture results were recorded. The receiver operating characteristic curve was used to perform predicting value assessments.

Of 60 episodes of peritonitis, 68.3% were treated successfully. Of the remaining episodes, 15.8% resulted in mortality, 57.9% required catheter removal, and 26.3% led to both. The mean PD effluent leukocyte count on the third day after initiating empiric antibiotics was significantly higher in the group with treatment failure (2258 ± 796/mm3) than in the group with successful treatment (1325 ± 669/mm3; P < .001). The cutoff point of 1240/mm3 was found with optimized sensitivity (100%), specificity (63.4%), positive predictive value (55.9%), and negative predictive value (100%) for prediction of treatment failure (P < .001).

This study showed that the third-day dialysis effluent leukocyte count predicted short outcomes of peritonitis.