Incidence and outcomes of encapsulating peritoneal sclerosis (EPS) and factors associated with severe EPS
Autor: | Shang-Chih Liao, Ben-Chung Cheng, I-Kuan Wang, Yu-Tzu Chang, Shih Yuan Hung, Jin-Bor Chen, An Bang Wu, Chin Chung Tseng, Chiu-Ching Huang |
---|---|
Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Male
Physiology medicine.medical_treatment 030232 urology & nephrology lcsh:Medicine Pathology and Laboratory Medicine Gastroenterology Severity of Illness Index Diagnostic Radiology Geographical Locations 0302 clinical medicine Risk Factors Ascites Medicine and Health Sciences 030212 general & internal medicine lcsh:Science Tomography Multidisciplinary Incidence (epidemiology) Mortality rate Incidence Radiology and Imaging Peritoneal Fibrosis Middle Aged Nephrology Female medicine.symptom Research Article Adult medicine.medical_specialty Asia Death Rates Imaging Techniques Taiwan Peritonitis Surgical and Invasive Medical Procedures Neuroimaging Gastroenterology and Hepatology Research and Analysis Methods Peritoneal dialysis Calcification 03 medical and health sciences Signs and Symptoms Population Metrics Diagnostic Medicine Internal medicine Severity of illness Medical Dialysis medicine Humans Retrospective Studies Population Biology business.industry lcsh:R Biology and Life Sciences Retrospective cohort study medicine.disease Computed Axial Tomography People and Places lcsh:Q Complication business Physiological Processes Neuroscience |
Zdroj: | PLoS ONE, Vol 13, Iss 1, p e0190079 (2018) PLoS ONE |
ISSN: | 1932-6203 |
Popis: | Background Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of long-term peritoneal dialysis (PD). However, previous studies reported large variations in its mortality rates that may associate with a different degree of EPS severity. This study reports the incidence and outcomes of EPS and identifies the risk factors associated with severe EPS. Methods We retrospectively analyzed clinical data of EPS patients from 3 medical centers in Taiwan from January 1982 to September 2015, and classified patients as having mild/moderate or severe EPS. Patients with intractable intestinal obstruction/gut-related sepsis that needed surgical intervention or resulted in mortality were in severe EPS group. Follow-up for outcome was through December 31, 2015. Clinical characteristics, peritoneal dialysis (PD)-related parameters, biochemical and imaging results were analyzed and compared between groups. Results Fifty-eight of 3202 patients undergoing PD during the study period had EPS (prevalence 1.8%). The incidence of EPS increased for patients on PD for >6–8 years (≤6 yrs. vs. >6–8 yrs., 0.0% vs. 1.8%, p = 0.001). Relative to those on PD for >6–8 years, the risk of EPS significantly increased with PD duration longer than 10 years (>10–12 years vs. >6–8 years: OR: 5.5, 95% CI: 1.7–17.1, p < 0.01). Twenty-three patients fulfilled the criteria for severe EPS. The overall mortality rate of EPS was 35% (20/58), and was 74% (17/23) in the severe EPS group. The average serum levels of C-reactive protein (CRP) and intact-parathyroid hormone (i-PTH), which were checked every 3~6 months within one year before diagnosis of EPS, were higher in severe EPS group than in mild/moderate group (p = 0.02, p = 0.08, respectively). Multivariate analysis revealed severe EPS was independently associated with bowel tethering (based on CT), presentation with bloody ascites, diagnosis of EPS after withdrawal from PD, and i-PTH ≥ 384 pg/mL. Receiver operating characteristic analysis indicated that presentation with 2 or more of the 5 risk factors (EPS diagnosis after PD withdrawal, bloody ascites, bowel tethering, CRP ≥ 29 mg/L, and i-PTH ≥ 384 pg/mL) had a good accuracy (AUC = 0.80, p = 0.001) for prediction of severe EPS. Conclusions The incidence of EPS increases with PD duration. Severe EPS has high mortality rate and is associated with bowel tethering, presentation of bloody ascites, diagnosis after PD withdrawal, and higher serum levels of i-PTH before EPS diagnosis. Having 2 or more of the 5 risk factors can provide a good accuracy for prediction of severe EPS. |
Databáze: | OpenAIRE |
Externí odkaz: | |
Nepřihlášeným uživatelům se plný text nezobrazuje | K zobrazení výsledku je třeba se přihlásit. |