{"title":"难治性腹水丹佛腹膜静脉分流的生物标志物引导策略：一项回顾性单中心研究。","authors":"Yuhi Shimura, Shohei Komatsu, Yoshimasa Hashimoto, Miho Nishio, Yu Hashimoto, Michihiko Yoshida, Toshihiko Yoshida, Kenji Fukushima, Itsuo Fujita, Takumi Fukumoto","doi":"10.1007/s00423-025-03710-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the utility of peritoneovenous shunt (PVS) placement for refractory ascites (RA) based on preoperative biomarkers.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with malignant and cirrhotic RA undergoing PVS placement treated at Sumoto Itsuki Hospital between January 2001 and March 2024. The efficacy of PVSs was defined according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). The usefulness of the prognostic nutritional index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and C-reactive protein-to-albumin ratio as prognostic indicators for the efficiency of PVS was evaluated.</p><p><strong>Results: </strong>In total, 149 consecutive patients (malignant RA, n = 100; cirrhotic RA, n = 49) were included in this study. PVS placement satisfied the efficacy criteria for ascites in 102 (68%) patients in the entire cohort. The estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m<sup>2</sup> was an independent predictor for the inefficacy of PVSs (odds ratio: 2.82, 95% CI: 1.04-7.73, P = 0.042). Based on receiver operating characteristic curve and multivariate analysis of the entire cohort, NLR ≥ 5.8 was an independent risk factor for death within 1 week after PVS placement (odds ratio: 18.2, 95% CI: 2.07-29.7, P = 0.016).</p><p><strong>Conclusion: </strong>PVS placement for RA may be a treatment option when preoperative eGFR is > 30 mL/min/1.73 m<sup>2</sup> and NLR is < 5.8.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"140"},"PeriodicalIF":2.1000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018634/pdf/","citationCount":"0","resultStr":"{\"title\":\"Biomarker-guided strategy for Denver peritoneovenous shunts in refractory ascites: a retrospective single-center study.\",\"authors\":\"Yuhi Shimura, Shohei Komatsu, Yoshimasa Hashimoto, Miho Nishio, Yu Hashimoto, Michihiko Yoshida, Toshihiko Yoshida, Kenji Fukushima, Itsuo Fujita, Takumi Fukumoto\",\"doi\":\"10.1007/s00423-025-03710-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This study aimed to evaluate the utility of peritoneovenous shunt (PVS) placement for refractory ascites (RA) based on preoperative biomarkers.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with malignant and cirrhotic RA undergoing PVS placement treated at Sumoto Itsuki Hospital between January 2001 and March 2024. The efficacy of PVSs was defined according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). The usefulness of the prognostic nutritional index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and C-reactive protein-to-albumin ratio as prognostic indicators for the efficiency of PVS was evaluated.</p><p><strong>Results: </strong>In total, 149 consecutive patients (malignant RA, n = 100; cirrhotic RA, n = 49) were included in this study. PVS placement satisfied the efficacy criteria for ascites in 102 (68%) patients in the entire cohort. The estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m<sup>2</sup> was an independent predictor for the inefficacy of PVSs (odds ratio: 2.82, 95% CI: 1.04-7.73, P = 0.042). 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引用次数: 0
摘要
目的：本研究旨在评估基于术前生物标志物的腹膜静脉分流（PVS）放置治疗难治性腹水（RA）的效用。方法：这项回顾性队列研究包括2001年1月至2024年3月期间在Sumoto Itsuki医院接受PVS放置治疗的恶性和肝硬化RA患者。pvs的疗效根据美国国家癌症研究所不良事件通用术语标准（CTCAE）定义。评估预后营养指数、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值、淋巴细胞与单核细胞比值和c反应蛋白与白蛋白比值作为PVS疗效的预后指标的有效性。结果：共149例患者(恶性RA， n = 100；肝硬化类风湿性关节炎（n = 49）纳入本研究。在整个队列中，102例（68%）患者的PVS放置满足腹水的疗效标准。估计肾小球滤过率(eGFR)≤30 mL/min/1.73 m2是pvs无效的独立预测因子（优势比：2.82,95% CI: 1.04-7.73, P = 0.042）。根据受试者工作特征曲线和整个队列的多因素分析，NLR≥5.8是PVS放置后1周内死亡的独立危险因素（优势比：18.2,95% CI: 2.07-29.7, P = 0.016）。结论：术前eGFR为30ml /min/1.73 m2， NLR为30ml /min/1.73 m2时，PVS放置可能是治疗RA的一种选择
Biomarker-guided strategy for Denver peritoneovenous shunts in refractory ascites: a retrospective single-center study.
Purpose: This study aimed to evaluate the utility of peritoneovenous shunt (PVS) placement for refractory ascites (RA) based on preoperative biomarkers.
Methods: This retrospective cohort study included patients with malignant and cirrhotic RA undergoing PVS placement treated at Sumoto Itsuki Hospital between January 2001 and March 2024. The efficacy of PVSs was defined according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). The usefulness of the prognostic nutritional index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and C-reactive protein-to-albumin ratio as prognostic indicators for the efficiency of PVS was evaluated.
Results: In total, 149 consecutive patients (malignant RA, n = 100; cirrhotic RA, n = 49) were included in this study. PVS placement satisfied the efficacy criteria for ascites in 102 (68%) patients in the entire cohort. The estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73 m2 was an independent predictor for the inefficacy of PVSs (odds ratio: 2.82, 95% CI: 1.04-7.73, P = 0.042). Based on receiver operating characteristic curve and multivariate analysis of the entire cohort, NLR ≥ 5.8 was an independent risk factor for death within 1 week after PVS placement (odds ratio: 18.2, 95% CI: 2.07-29.7, P = 0.016).
Conclusion: PVS placement for RA may be a treatment option when preoperative eGFR is > 30 mL/min/1.73 m2 and NLR is < 5.8.
期刊介绍：
Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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