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Measurement of innate immune response biomarkers in peritoneal dialysis effluent using a rapid diagnostic point-of-care device as a diagnostic indicator of peritonitis

Goodlad, Catriona, George, Sophiamma, Sandoval, Shella, Mepham, Stephen, Parekh, Gita, Eberl, Matthias, Topley, Nicholas and Davenport, Andrew 2020. Measurement of innate immune response biomarkers in peritoneal dialysis effluent using a rapid diagnostic point-of-care device as a diagnostic indicator of peritonitis. Kidney International 97 (6) , pp. 1253-1259. 10.1016/j.kint.2020.01.044
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Abstract

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 3.5 months (interquartile range 6.4 – 31.5 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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0085-2538
Date of First Compliant Deposit: 30 March 2020
Date of Acceptance: 30 January 2020
Last Modified: 11 Sep 2020 08:39
URI: http://orca-mwe.cf.ac.uk/id/eprint/130632

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