Risk factors associated with treatment failure in peritoneal dialysis-associated peritonitis

Within the present study, the aim was to identify the factors associated with treatment failure in peritoneal dialysis-associated peritonitis (PDAP), thereby enabling earlier clinical identification and timely recognition of patients at an increased risk of worse prognosis. The present retrospective study utilized patients diagnosed with PDAP at the Affiliated Yongchuan Hospital of Chongqing Medical University (Chongqing, China), between May 2016 and December 2024. PDAP episodes were classified as treatment success or failure. Baseline clinical features and relevant laboratory indices were compared across the two groups. Potential risk factors for PDAP were explored using Least Absolute Shrinkage and Selection Operator (LASSO) regression in conjunction with generalized estimating equation (GEE) logistic regression analysis. The discriminative performance of the identified predictors for treatment failure was subsequently assessed through receiver operating characteristic (ROC) curve analysis. A total of 72 patients undergoing peritoneal dialysis experienced 103 PDAP episodes. Among these, 71 episodes (68.93%) resulted in treatment success and 32 (31.07%) resulted in treatment failure. LASSO regression identified four potential predictors. GEE logistic regression analysis showed that D-dimer [odds ratio (OR)=3.57; 95% CI: 1.83-6.95; P<0.001], systemic inflammatory response index (SIRI; OR=1.10; 95% CI: 1.05-1.15; P<0.001) and serum phosphorus (OR=3.16; 95% CI: 1.14-8.76; P=0.027) were independent risk factors for treatment failure in PDAP episodes. ROC analysis indicated that D-dimer exhibited the highest predictive performance [area under the curve (AUC)=0.76; 95% CI: 0.64-0.86], with an optimal cutoff value of 1.39 (sensitivity: 62.5%; specificity: 83.1%), outperforming SIRI (AUC=0.67; 95% CI: 0.54-0.80) and serum phosphorus (AUC=0.64; 95% CI: 0.51-0.76). The present study concluded that elevated D-dimer, SIRI and serum phosphorus were independently associated with treatment failure in PDAP, with D-dimer level demonstrating the strongest predictive value.