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
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