P1224ROLE OF DIAGNOSTIC IMAGING DURING PERITONITIS IN PERITONEAL DIALYSIS PATIENTS

Abstract

Abstract Background and Aims Peritonitis in peritoneal dialysis (PD) patients can be directly related to PD or secondary to intrabdominal infection (secondary peritonitis). The indication and role of imaging of abdomen during peritonitis in PD patients is unclear. Method This was a single center, retrospective study, including all the first episode of peritonitis in incident PD patients from the period of January 2013 to October 2017. Primary aim of the study was to identify the incidence of secondary peritonitis diagnosed by imaging of abdomen (defined as positive scan finding of intraabdominal lesions) in PD patients with peritonitis. Secondary outcomes were predictors for secondary peritonitis analyzed by multivariable logistic regression. Results There were total 527 incident PD patients during the study period. Of these, 153 patients (29%) developed at least one episode of peritonitis. The mean age of patients with peritonitis was 57.7 ± 3.4 years, 49 % were male, and 52% had diabetes mellitus. Out of 153, 78 patients (51%) underwent diagnostic imaging of abdomen to look for secondary peritonitis. Majority of them had contrast enhanced computed tomography (CT) scan (95%) and the remaining had non-contrast CT scan or ultrasound of abdomen. Of 78 patients who underwent scan, 12 patients (16%) were reported to have intra-abdominal lesions (secondary peritonitis) including colitis (n=2), pancreatitis (n=1), cholecystitis (n=4), appendicitis (n=1), intestinal obstruction (n=2), liver abscess (n=1), gastric cancer (n=1). According to the causative micro-organisms, the positive scan finding of intra-abdominal lesions was more commonly observed in Gram-negative peritonitis (n=7, 58%), followed by fungal/mycobacterial peritonitis (n=2, 17%), Gram-positive peritonitis (n=2, 17%), polymicrobial peritonitis (n=1, 8%), but none (0%) in culture negative peritonitis. Among patients with Gram-negative peritonitis who underwent the imaging of abdomen, only 12% (7/58) were reported to have intra-abdominal lesions. In multivariable logistic regression, the presenting symptoms including fever (odds ratio (OR) 1.51, 95% confidence interval (CI) 0.40 – 5.68), abdominal pain (OR 1.08, 95% CI 0.24 -1.78), presence of cloudy of effluent (OR 0.66, 95% CI 0.19 -2.29), hypotension on presentation (OR 3.61, 95% CI 0.75 -17.46) or effluent white cell counts on presentation (OR 0.99, 95% CI 0.93 -1.05) were not significantly associated with secondary peritonitis. Conclusion A considerable number of patients underwent imaging of abdomen during peritonitis regardless of causative organisms, only a few of them had intra-abdominal lesions. Future prospective study is needed to guide the role of imaging in PD patients during peritonitis.