Diagnostic value of ultrasonographic measurement of peritoneal, mesenteric and intestinal wall thickness in children with peritoneal dialysis-related peritonitis: a preliminary clinical study

Abstract Background Peritonitis is a common serious complication of peritoneal dialysis. Although peritoneal thickening is commonly observed in long-term peritoneal dialysis patients, there have been relatively few studies on mesenteric and intestinal wall alterations through ultrasonography, particularly in pediatric patients. We aim to determine the value of ultrasonographic measurement in children with peritoneal dialysis-related peritonitis. Methods We recruited two groups of pediatric patients, of whom 40 had peritonitis (study group) and 42 had no peritonitis (control group). We measured peritoneal, mesenteric and intestinal wall thickness by trans-abdominal ultrasonography. To identify risk factors and develop a predictive nomogram for peritonitis, we employed multivariate logistic regression analysis. Subsequently, the performance of the nomogram model was assessed through the ROC curve, calibration curve, and decision curve analysis (DCA). Results The ultrasonographic measurements of the peritoneal thickness, mesenteric thickness, jejunal wall and ileal wall thickness in peritonitis group were significantly thicker than the non-peritonitis group. The peritonitis group had significantly higher NLR (neutrophil-to-lymphocyte ratio) and significantly lower albumin and uric acid levels than the non-peritonitis group. Multivariate Logistic analysis showed that dialysis duration, mesenteric thickness, jejunal wall thickness and NLR were potential associated factors. ROC curve showed that the integrated predictive model exhibited superior diagnostic accuracy (AUC = 0.873) over that of any single predictive parameter ( P < 0.05). The nomogram model showed good calibration and clinical benefit. Conclusions High-frequency ultrasound effectively supports the diagnosis of peritoneal dialysis-related peritonitis. The integrated predictive model based on ultrasonographic measurements is effective for predicting the recurrent PD-related peritonitis in children and offering practical ultrasonographic criteria.