title: Clinical characteristics and outcomes of peritoneal dialysis-related peritonitis with different trends of change in effluent white cell count: a longitudinal study.
abstract: 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.affiliation: Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Xu
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chen
authors.forename: Suping
authors.initials: S
authors.lastname: Luo
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.forename: Bo
authors.initials: B
authors.lastname: Zheng
authors.forename: Yingdong
authors.initials: Y
authors.lastname: Zheng
authors.forename: Jie
authors.initials: J
authors.lastname: Dong
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects; D015314:Dialysis Solutions / Q000737:chemistry*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000097:blood* / Q000209:etiology; D011379:Prognosis
chemical_list: D015314:Dialysis Solutions
keywords: Peritonitis; outcomes; peritoneal effluent