Clinical Significance of Ascitic Fluid Polymorphonuclear Leukocyte Percentage in Patients With Cirrhosis Without Spontaneous Bacterial Peritonitis.
Clinical Significance of Ascitic Fluid Polymorphonuclear Leukocyte Percentage in Patients With Cirrhosis Without Spontaneous Bacterial Peritonitis.
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DOI：
10.14309/ctg.0000000000000614
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发表时间：
2023-09-01
影响因子：
3.6
通讯作者：
Saito, Takeshi
中科院分区：
文献类型：
--
作者：
Dawit, Lillian;Lee, Vivian;Lehoang, David;Furey, Cameron;Chowdhury, Aneesa;Thu Anne Mai;Angajala, Varun;Park, Joo Hye;Khadarian, Kevork;She, Rosemary;Vergara-Lluri, Maria;Kahn, Jeffrey;Dodge, Jennifer L.;Saito, Takeshi
关键词：
腹水中多形核白细胞绝对计数(PMN-C)≥为250cell/mm~3是自发性细菌性腹膜炎的诊断标志，与高发病率和高死亡率有关。然而，在无SBP的情况下，腹水PMN百分比(PMN-%)和PMN-C作为死亡率和SBP未来发病率的附加生物标志物的临床意义尚未确定。这一回顾性队列包括2015至2020年间在两个三级医疗中心接受首次记录的经皮穿刺术的成人肝硬变患者，初始PMN-C和250细胞/mm3。有SBP史的患者被排除在外。结果是死亡和SBP的发展。Cox回归估计死亡风险和SBP发生的危险比(HRs)，Akaike信息标准比较模型拟合。384名成人(73%男性，中位年龄58岁，67%患有酒精性肝硬变，中位数PMN-C14细胞/mm~3[四分位数范围5-34]，中位数PMN-%10%[四分位数范围4-20])纳入本研究。PMN-C每增加25个单位，单变量死亡风险增加10%(95%可信区间1.01-1.21，P=0.03)，PMN-%每增加10个单位增加19%(95%可信区间1.06-1.33，P=0.003)，PMN-%显示更好的模型拟合(Akaike信息标准：1,044比1,048)。在调整了年龄、慢性丙型肝炎病毒感染和终末期肝病模型-钠的模型中，PMN-%与死亡风险(PMN-%10%-29%，HR 1.17，P=0.5；PMN-%≥30%组，HR 1.94，P=0.03；PMN-%≥发生(PMN-%10%-29%，HR 1.68，P=0.07；PMN-%≥30%，HR 3.48，P<；0.001；对PMN-%<；10%)。我们的结果表明，与PMN-C相比，首次穿刺术中PMN-%是评估PMN-C患者死亡风险和未来SBP发展的更好的生物标志物。
Absolute polymorphonuclear leukocyte (PMN) count (PMN-C) ≥250 cells/mm3 in ascites is the diagnostic hallmark of spontaneous bacterial peritonitis (SBP) and is associated with high morbidity and mortality. However, the clinical significance of ascitic PMN percentage (PMN-%) and PMN-C in the absence of SBP as additional biomarkers for mortality and future incidence of SBP has not been determined. This retrospective cohort included adults with cirrhosis undergoing first-recorded paracentesis with initial PMN-C < 250 cells/mm3 at 2 tertiary medical centers between 2015 and 2020. Patients with prior SBP were excluded. Outcomes were death and SBP development. Cox regression estimated hazard ratios (HRs) for risk of death and SBP development and Akaike information criterion to compare model fit. Three hundred eighty-four adults (73% male, median age 58 years, 67% with alcohol-associated cirrhosis, median PMN-C 14 cells/mm3 [interquartile range 5–34], and median PMN-% 10% [interquartile range 4–20]) were included in this study. Univariate risk of death increased 10% per 25-unit increase in PMN-C (95% confidence interval 1.01–1.21, P = 0.03) and 19% per 10-unit increase in PMN-% (95% confidence interval 1.06–1.33, P = 0.003) with PMN-% demonstrating better model fit in assessing mortality risk (Akaike information criterion: 1,044 vs 1,048, respectively). In models adjusted for age, chronic hepatitis C virus infection, and Model for End-Stage Liver Disease-Sodium, PMN-% was associated with risk of death (PMN-% 10%–29%, HR 1.17, P = 0.50; PMN-% ≥ 30% group, HR 1.94, P = 0.03; vs PMN-% < 10%) and SBP development (PMN-% 10%–29%, HR 1.68, P = 0.07; PMN-% ≥ 30%, HR 3.48, P < 0.001; vs PMN-% < 10%). Our results suggest PMN-% at first paracentesis represents a better biomarker compared with PMN-C for assessing risk of death and future SBP development in patients with PMN-C < 250 cells/mm3.
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DOI：
10.1016/s0140-6736(18)32203-7
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2017 Causes of Death Collaborators
通讯作者：
GBD 2017 Causes of Death Collaborators
影响因子：
2.9
作者：
Cho, Yuri;Park, So Youn;Lee, Hyo-Suk
通讯作者：
Lee, Hyo-Suk
影响因子：
7.6
作者：
Karvellas, C. J.;Abraldes, J. G.;Kumar, A.
通讯作者：
Kumar, A.
DOI：
10.1097/00042737-199701000-00017
发表时间：
1997-01-01
影响因子：
2.1
作者：
Kaymakoglu, S;Eraksoy, H;Besisik, F
通讯作者：
Besisik, F
DOI：
10.17235/reed.2017.4517/2016
发表时间：
2018-01-01
期刊：
Revista Española de Enfermedades Digestivas
影响因子：
--
作者：
Melcarne, Luigi;Sopeña, Julia;Casas, Meritxell
通讯作者：
Casas, Meritxell