Peritonitis is the commonest complication of peritoneal dialysis and a major reason for treatment failure. Current diagnosis is based on clinical symptoms, cloudy effluent and a dialysate white cell count (over 100 cells/μl). A rapid point-of-care diagnostic test would accelerate diagnosis and potentially improve outcomes from infection. Here, in a clinical audit project, we used PERiPLEX®, a point-of-care device which detects when levels of matrix metalloproteinase-8 and interleukin-6 are elevated above a threshold within minutes in dialysis effluent, to assess whether it could confirm or exclude peritonitis in 107 patients undergoing peritoneal dialysis. Mean patient age was 64.6 years with a median duration of peritoneal dialysis of 13.3 months (interquartile range 6.3 - 33.5 months). Presence of peritonitis was confirmed by clinical criteria. There were 49 positive tests of which 41 patients had peritonitis, three had other causes of intra-peritoneal inflammation, three had severe urosepsis and two patients required no treatment. Fifty-eight tests were negative with one patient having a false negative result. The positive predictive value of the test was 83.7% (95% confidence interval 72.8 - 90.8) and the negative predictive value was 98.3% (89.1 - 99.8). Sensitivity and specificity were 97.6% (87.4 - 99.9) and 87.7% (77.2 - 94.5) respectively. Thus, PERiPLEX® could be used as a rapid point-of-care test that can aid the diagnosis or exclusion of peritonitis with a high negative predictive value.

中文翻译：

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使用快速诊断床旁设备作为腹膜炎的诊断指标测量腹膜透析流出物中的先天免疫反应生物标志物。

腹膜炎是腹膜透析最常见的并发症，也是治疗失败的主要原因。目前的诊断基于临床症状、混浊流出物和透析液白细胞计数（超过 100 个细胞/μl）。快速的即时诊断测试将加速诊断并可能改善感染的结果。在这里，在一个临床审计项目中，我们使用了 PERiPLEX®，这是一种即时检测设备，可以检测透析流出物中基质金属蛋白酶 8 和白细胞介素 6 的水平何时在几分钟内升高到阈值以上，以评估它是否可以确认或排除 107 名接受腹膜透析的患者的腹膜炎。患者平均年龄为 64.6 岁，中位腹膜透析持续时间为 13.3 个月（四分位间距 6.3 - 33.5 个月）。通过临床标准证实存在腹膜炎。有 49 例阳性测试，其中 41 名患者患有腹膜炎，3 名患者有其他原因引起的腹膜内炎症，3 名患者患有严重的尿毒症，2 名患者无需治疗。58 项测试为阴性，一名患者的结果为假阴性。该试验的阳性预测值为 83.7%（95% 置信区间 72.8 - 90.8），阴性预测值为 98.3%（89.1 - 99.8）。敏感性和特异性分别为 97.6% (87.4 - 99.9) 和 87.7% (77.2 - 94.5)。因此，PERiPLEX® 可用作一种快速的床旁检测，可以帮助诊断或排除腹膜炎，具有很高的阴性预测值。58 项测试为阴性，一名患者的结果为假阴性。该试验的阳性预测值为 83.7%（95% 置信区间 72.8 - 90.8），阴性预测值为 98.3%（89.1 - 99.8）。敏感性和特异性分别为 97.6% (87.4 - 99.9) 和 87.7% (77.2 - 94.5)。因此，PERiPLEX® 可用作一种快速的床旁检测，可以帮助诊断或排除腹膜炎，具有很高的阴性预测值。58 项测试为阴性，一名患者的结果为假阴性。该试验的阳性预测值为 83.7%（95% 置信区间 72.8 - 90.8），阴性预测值为 98.3%（89.1 - 99.8）。敏感性和特异性分别为 97.6% (87.4 - 99.9) 和 87.7% (77.2 - 94.5)。因此，PERiPLEX® 可用作一种快速的床旁检测，可以帮助诊断或排除腹膜炎，具有很高的阴性预测值。