{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T18:32:45Z","timestamp":1784745165419,"version":"3.55.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004772","name":"Natural Science Foundation of Ningxia Province","doi-asserted-by":"publisher","award":["2022AAC02062"],"award-info":[{"award-number":["2022AAC02062"]}],"id":[{"id":"10.13039\/501100004772","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004772","name":"Natural Science Foundation of Ningxia Province","doi-asserted-by":"publisher","award":["2023AACO3568"],"award-info":[{"award-number":["2023AACO3568"]}],"id":[{"id":"10.13039\/501100004772","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Key R&D Program of Ningxia Autonomous Region","award":["2022BEG03120"],"award-info":[{"award-number":["2022BEG03120"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["No. 82360153"],"award-info":[{"award-number":["No. 82360153"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peritonitis is a serious complication of peritoneal dialysis (PD). Inflammatory indices derived from routine complete blood count (CBC) parameters\u2014including the pan-immune inflammatory value (PIV), systemic immune-inflammatory index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-monocyte ratio (PMR)\u2014have shown prognostic value in various diseases. However, their comparative utility in predicting PD-associated peritonitis (PDAP) remains unclear. This multicenter cohort study aimed to evaluate and compare these indices to identify the best predictor of PDAP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively enrolled 2,036 PD patients from 10 centers. The associations between inflammatory markers (PIV, SII, PLR, NLR, MLR, PMR) and peritonitis risk were analyzed using restricted cubic splines. Optimal cut-offs were determined by ROC analysis. Survival differences were assessed using Kaplan\u2013Meier curves and log-rank tests. Independent predictors were identified via multivariate Cox regression, with model discrimination evaluated by the C-index. Subgroup analyses were conducted by gender, age, body mass index (BMI), diabetes, albumin, PD vintage, and residual renal function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age was 51.0 years, 55.01% were male, and median dialysis vintage was 49.47 months. Diabetes prevalence was 21.02%. Over the follow-up, 147 patients (7.22%) developed peritonitis. Among the indices evaluated, PIV, SII, and PLR showed significant nonlinear associations with peritonitis risk (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Adjusted hazard ratios were 2.004 for PIV, 2.144 for SII, and 2.063 for PLR. Adjusted C-indices were 0.67 (PIV), 0.70 (SII), and 0.70 (PLR). No significant interactions were found in subgroup analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated PIV, SII, and PLR levels at PD initiation independently predict higher peritonitis risk. Although their discriminative ability is moderate, these routine, cost-effective indices may aid risk stratification and help identify patients needing closer monitoring or preventive interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354120","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T17:39:54Z","timestamp":1784741994000},"page":"e0354120","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive value of complete blood cell count-based inflammatory markers for peritonitis risk in peritoneal dialysis patients: A multicenter cohort 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Su","year":"2024","journal-title":"Oncol Lett"},{"issue":"6","key":"pone.0354120.ref025","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.kint.2018.12.030","article-title":"CX3CL1-CX3CR1 interaction mediates macrophage-mesothelial cross talk and promotes peritoneal fibrosis","volume":"95","author":"A Helmke","year":"2019","journal-title":"Kidney Int"},{"issue":"3","key":"pone.0354120.ref026","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1189\/jlb.0810479","article-title":"Neutrophil IL-10 suppresses peritoneal inflammatory monocytes during polymicrobial sepsis","volume":"89","author":"LM Ocuin","year":"2011","journal-title":"J Leukoc Biol"},{"issue":"1","key":"pone.0354120.ref027","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12882-024-03496-z","article-title":"The association between new inflammation markers and frequent peritoneal dialysis-associated peritonitis","volume":"25","author":"J Tang","year":"2024","journal-title":"BMC 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