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KMID : 1102220230420010127
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Kidney Research and Clinical Practice
2023 Volume.42 No. 1 p.127 ~ p.137
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Optimal peritoneal fluid white blood cell count for diagnosis of peritonitis in peritoneal dialysis patients
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Margarita Kunin
Sharon Mini
Nabil Abu-Amer
Pazit Beckerman
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Abstract
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Background: The diagnosis of peritonitis among peritoneal dialysis (PD) patients is based on clinical presentation, dialysis effluentwhite blood cell (WBC) count, and dialysis effluent culture. Peritoneal fluid WBC count is very important in the initial diagnosis of peritonitis.The purpose of this work was to determine the optimal number of peritoneal WBCs with different clinical presentations at admissionto define PD-related peritonitis.
Methods: Medical records of chronic PD patients who underwent work-up for suspected peritonitis between 2008 and 2019 were reviewedretrospectively. Results of all peritoneal WBC count tests during this period were collected. Clinical manifestations and follow-up analysis of each peritoneal WBC count were performed.
Results: The peritoneal WBC count cutoff of 100/μL recommended by International Society for Peritoneal Dialysis provided specificityof only 35%. Increasing peritoneal WBC count cutoff to 150, 200, and 250/μL provided sensitivity around 98% and gradually increasingspecificity. The chi-square automatic interaction detector model of statistical analysis determined that peritoneal WBC count below230/μL combined with absence of inflammatory markers (fever, increased C-reactive protein) ruled out peritonitis with 99.8%sensitivity. Peritoneal fluid WBC count cutoff of 230/μL provided specificity of 89% and good positive and negative likelihood scoresof 8.3 and 0.03, respectively. Peritoneal fluid polymorphonuclear count has lower discriminating ability for peritonitis compared toperitoneal fluid WBC count.
Conclusion: Increasing peritoneal fluid WBC count cutoff to 230/μL in suspected PD-related peritonitis could improve specificity withoutcompromising the sensitivity of the test.
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KEYWORD
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Abdominal pain, Peritoneal dialysis, Peritonitis, White blood cells
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