
Association between platelet/lymphocyte ratio and frequent peritoneal dialysis-associated peritonitis in peritoneal dialysis patients
Yuan Jing, Yang Yuqi, Liu Lu, Yu Fangfang, Qie Shuwen, Yang Li, Zha Yan
Association between platelet/lymphocyte ratio and frequent peritoneal dialysis-associated peritonitis in peritoneal dialysis patients
Objective To explore the association between platelet/lymphocyte ratio (PLR) and frequent peritoneal dialysis (PD)-associated peritonitis (PDAP) in PD patients. Methods The data of PD patients with PDAP from Guizhou Provincial People's Hospital between January 2015 and June 2019 were analyzed retrospectively. The patients were divided into mono group (only once PDAP occurred in one year) and frequent group (2 or more PDAP occurred in one year) according to the frequency of PDAP. The demographic data including gender, age, height and weight, the clinical data including blood pressure, duration of PD, causes of peritonitis, the laboratory data at the first time of PDAP and the prognosis of PDAP were compared between two groups. Logistic regression analysis method was applied to analyze the relationship between PLR and frequent PDAP. The predictive power of PLR was evaluated by receiver operating characteristic curve (ROC). Results A total of 78 PD patients with PDAP were enrolled, including 53 males and 25 females, with average age of 45.2 years. The total person-year was 765.1 person-years and the incidence of peritonitis was 0.10 case/person-year during the median follow-up of 16 months. All patients were divided into two groups: 53 patients in mono group and 25 patients in frequent group. Compared with mono group, the patients in frequent group had lower body mass index, longer dialysis duration, higher systolic blood pressure level, higher PLR level, lower uric acid level, and higher rate of drug-resistant bacteria in peritoneal effusion (all P<0.05). The extubation rate of the frequent group was 44.0%(11/25), which was significantly higher than that [15.1%(8/53)] of mono group (P<0.05). Multivariate logistic regression analysis showed that higher PLR level was an independent related factor for frequent PDAP(OR=1.006, 95%CI 1.002-1.010, P=0.003), and the area under the ROC curve of PLR was 0.783(95%CI 0.663-0.904, P<0.001). Conclusions High PLR level is an independent related factor of frequent PDAP for PD patients, and PLR can be a potential predictor of frequent PDAP.
Peritoneal dialysis / Peritonitis / Blood platelets / Lymphocytes / Frequency {{custom_keyword}} /
表1 两组患者临床资料比较 |
项目 | 总体(n=78) | 单发组(n=53) | 频发组(n=25) | t/χ2/Z | P值 |
---|---|---|---|---|---|
男性[例(%)] | 53(67.9) | 35(66.0) | 18(72.0) | 0.269 | 0.604 |
年龄(岁) | 45.2±16.0 | 44.4±15.7 | 47.2±16.6 | -1.064 | 0.291 |
体重指数(kg/m2) | 21.6±3.8 | 22.5±4.1 | 20.3±3.1 | 2.231 | 0.030 |
透析龄(月) | 16.0(4.0,26.5) | 9.0(4.0,25.0) | 21.0(16.0,30.5) | -2.373 | 0.018 |
基础病[例(%)] | 0.458 | 0.928 | |||
慢性肾小球肾炎 | 39(50.0) | 24(45.3) | 13(52.0) | ||
糖尿病肾病 | 19(24.4) | 14(26.4) | 5(20.0) | ||
高血压肾损害 | 16(20.5) | 11(20.8) | 5(20.0) | ||
其他 | 6(7.7) | 4(7.5) | 2(8.0) | ||
诱因[例(%)] | 4.063 | 0.255 | |||
操作不当 | 35(44.9) | 26(49.1) | 9(36.0) | ||
环境不达标 | 8(10.3) | 3(5.7) | 5(20.0) | ||
肠道感染 | 32(41.0) | 22(41.5) | 10(40.0) | ||
出口隧道感染 | 3(3.8) | 2(3.8) | 1(4.0) | ||
收缩压(mmHg) | 146.2±24.3 | 140.4±25.9 | 153.3±19.9 | -2.058 | 0.044 |
舒张压(mmHg) | 90.6±15.6 | 88.0±17.0 | 93.0±14.3 | -1.180 | 0.243 |
发病至就诊时间(d) | 3.0(1.0,5.0) | 3.0(1.0,5.0) | 2.9(1.0,5.6) | -0.861 | 0.389 |
注:1 mmHg=0.133 kPa;数据形式除已注明外,呈正态分布的计量资料采用 |
表2 两组患者实验室指标比较 |
实验室指标 | 总体(n=78) | 单发组(n=53) | 频发组(n=25) | t/Z | P值 |
---|---|---|---|---|---|
白细胞计数(×109/L) | 7.4±3.6 | 7.7±3.6 | 6.7±3.6 | 1.067 | 0.289 |
中性粒细胞(×109/L) | 5.8±3.8 | 6.1±3.9 | 5.1±3.5 | 1.068 | 0.289 |
淋巴细胞(×109/L) | 1.1±0.6 | 1.0±0.6 | 1.1±0.6 | -0.272 | 0.786 |
NLR | 5.4(3.1,9.9) | 5.8(3.3,10.5) | 4.0(2.3,8.0) | -1.381 | 0.167 |
红细胞计数(×1012/L) | 3.4±0.9 | 3.4±1.0 | 3.3±0.7 | 0.378 | 0.707 |
血红蛋白(g/L) | 95.1±22.2 | 94.1±23.6 | 97.1±19.2 | -0.548 | 0.586 |
血小板计数(×109/L) | 213.7±84.1 | 221.5±91.0 | 197.1±65.9 | 1.196 | 0.235 |
PLR | 217.9(143.1,385.2) | 173.9(136.4,236.5) | 428.3(214.3,586.3) | -4.021 | <0.001 |
血尿素氮(mmol/L) | 14.5±7.9 | 14.5±8.5 | 14.4±6.8 | 0.045 | 0.964 |
血肌酐(μmol/L) | 854.9±338.9 | 898.2±350.4 | 764.9±300.4 | 1.635 | 0.106 |
血尿酸(μmol/L) | 359.4±95.3 | 375.5±104.4 | 328.4±66.3 | 2.047 | 0.044 |
血钙(mmol/L) | 2.1±0.3 | 2.1±0.3 | 2.1±0.2 | -0.150 | 0.881 |
血磷(mmol/L) | 1.4±0.6 | 1.5±0.6 | 1.3±0.5 | 1.440 | 0.154 |
血清总蛋白(g/L) | 56.4±8.6 | 56.7±8.5 | 55.6±9.0 | 0.524 | 0.602 |
血清白蛋白(g/L) | 26.6±6.8 | 26.9±7.5 | 25.9±5.3 | 0.569 | 0.571 |
iPTH(ng/L) | 192.8(85.5,412.1) | 254.6(106.6,466.5) | 137.2(83.0,227.5) | 1.790 | 0.074 |
CRP(mg/L) | 52.5(14.9,138.0) | 38.1(12.5,126.4) | 68.8(15.0,160.0) | -0.599 | 0.549 |
注:NLR:中性粒细胞/淋巴细胞比值;PLR:血小板/淋巴细胞比值;iPTH:全段甲状旁腺素;CRP:C反应蛋白;呈正态分布的计量资料采用 |
表3 两组患者病原菌组成比较 |
菌种 | 总体(n=78) | 单发组(n=53) | 频发组(n=25) | χ2 | P值 |
---|---|---|---|---|---|
革兰阳性菌[例(%)] | 30(38.5) | 19(35.8) | 11(44.0) | 0.477 | 0.328 |
革兰阴性菌[例(%)] | 16(20.5) | 9(17.0) | 7(28.0) | 1.265 | 0.203 |
真菌[例(%)] | 2(2.6) | 1(1.9) | 1(4.0) | 0.271 | 0.447 |
培养阴性[例(%)] | 30(38.5) | 24(45.3) | 6(24.0) | 3.251 | 0.040 |
耐药菌[例(%)] | 20(25.6) | 8(15.1) | 12(48.0) | 9.647 | 0.002 |
表4 频发性腹膜透析相关性腹膜炎发生的相关因素(Logistic回归分析,n=78) |
因素 | 单因素分析 | 多因素分析 | ||||
---|---|---|---|---|---|---|
OR | 95%CI | P值 | OR | 95%CI | P值 | |
透析时间(月) | 1.032 | 0.996~1.070 | 0.086 | 1.039 | 0.986~1.095 | 0.148 |
体重指数(kg/m2) | 0.823 | 0.685~0.989 | 0.037 | 0.879 | 0.705~1.097 | 0.255 |
收缩压(mmHg) | 1.025 | 1.000~1.050 | 0.052 | 1.008 | 0.971~1.046 | 0.684 |
血小板/淋巴细胞比值 | 1.007 | 1.004~1.011 | <0.001 | 1.006 | 1.002~1.010 | 0.003 |
血尿酸(μmol/L) | 0.994 | 0.987~1.000 | 0.049 | 0.995 | 0.987~1.004 | 0.304 |
注:1 mmHg=0.133 kPa |
表5 两组患者转归情况比较[例(%)] |
转归 | 总体(n=78) | 单发组 (n=53) | 频发组 (n=25) | χ2 | P值 |
---|---|---|---|---|---|
治疗有效 | 53(67.9) | 43(81.1) | 10(40.0) | 13.196 | <0.001 |
死亡 | 6(7.7) | 2(3.8) | 4(16.0) | 3.576 | 0.068 |
无效拔管 | 19(24.4) | 8(15.1) | 11(44.0) | 7.703 | 0.006 |
[1] |
Peritonitis is a major complication of peritoneal dialysis, but the relationship between peritonitis and mortality among these patients is not well understood. In this case-crossover study, we included the 1316 patients who received peritoneal dialysis in Australia and New Zealand from May 2004 through December 2009 and either died on peritoneal dialysis or within 30 days of transfer to hemodialysis. Each patient served as his or her own control. The mean age was 70 years, and the mean time receiving peritoneal dialysis was 3 years. In total, there were 1446 reported episodes of peritonitis with 27% of patients having ≥ 2 episodes. Compared with the rest of the year, there were significantly increased odds of peritonitis during the 120 days before death, although the magnitude of this association was much greater during the 30 days before death. Compared with a 30-day window 6 months before death, the odds for peritonitis was six-fold higher during the 30 days immediately before death (odds ratio, 6.2; 95% confidence interval, 4.4-8.7). In conclusion, peritonitis significantly associates with mortality in peritoneal dialysis patients. The increased odds extend up to 120 days after an episode of peritonitis but the magnitude is greater during the initial 30 days.
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[2] |
The causes, predictors, treatment, and outcomes of relapsed and recurrent peritoneal dialysis (PD)-associated peritonitis are poorly understood.Observational cohort study using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data.All Australian PD patients between October 1, 2003, and December 31, 2007, with first episodes of peritonitis.Demographic, clinical, and facility variables and type of peritonitis; relapse (same organism or culture-negative episode occurring within 4 weeks of completion of therapy of a prior episode or 5 weeks if vancomycin used); recurrence (different organism occurring within 4 weeks of completion of therapy of a prior episode or 5 weeks if vancomycin used); control (first peritonitis episode without relapse or recurrence).Hospitalization, catheter removal, hemodialysis therapy transfer, death.Of 6,024 PD patients studied, first episodes of relapsed, recurrent, and control peritonitis occurred in 356, 165, and 2,021 patients, respectively. Coagulase-negative staphylococci and Staphylococcus aureus accounted for 48% of relapsing peritonitis (adjusted OR, 1.26 [95% CI, 0.94-1.70] and 1.54 [95% CI, 1.08-2.19], respectively), but were much less likely to be isolated in recurrent peritonitis. Recurrent peritonitis was associated more frequently with fungi (13%; OR, 2.16; 95% CI, 1.12-4.17). The empirical antimicrobial approaches to relapsing and recurrent peritonitis were similar and their subsequent clinical outcomes were comparable. Compared with uncomplicated peritonitis, relapsed and recurrent peritonitis were associated with higher rates of catheter removal (22% vs 30% vs 37%, respectively; P < 0.001) and permanent hemodialysis therapy transfer (20% vs 25% vs 32%; P < 0.001), but similar rates of hospitalization (73% vs 70% vs 70%) and death (2.8% vs 2.0% vs 1.2%).Limited covariate adjustment. Residual confounding and coding bias could not be excluded.Relapsed and recurrent peritonitis are caused by different spectra of micro-organisms, but are not readily clinically distinguishable at presentation. Empirical treatment with broad-spectrum antibiotics and subsequent adjustment according to antimicrobial susceptibilities results in similar clinical outcomes, albeit with appreciably higher rates of catheter removal and hemodialysis therapy transfer than for uncomplicated peritonitis.Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.
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[3] |
万程, 杨聚荣, 张炜炜, 等. 腹膜透析相关腹膜炎危险因素分析[J]. 临床内科杂志, 2014, 31(4): 240-242. DOI: 10.3969/j.issn.1001-9057.2014.04.006.
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[4] |
唐碧雯, 方炜, 严豪, 等. 371例次腹膜透析相关性腹膜炎的预后分析[J]. 中华肾脏病杂志, 2013, 29(11): 808-811. DOI: 10.3760/cma.j.issn.1001-7097.2013.11.003.
目的 分析本中心腹膜透析(腹透)相关性腹膜炎患者治疗的转归与预后,为腹透相关性腹膜炎的防治提供依据。 方法 入选2004年1月1日至2010年12月31日在上海交通大学医学院附属仁济医院腹透中心接受腹透治疗并发生腹透相关性腹膜炎的所有患者,分析7年间腹透相关性腹膜炎患者的转归与预后。 结果 研究期间共有220例患者发生了371次腹膜炎,腹膜炎发生率为1次/54.4患者·月。其中285 例次(76.8%)的腹膜炎治愈,17例次(4.6%)的腹膜炎导致患者拔管转临时血液透析(血透),46例次(12.4%)的腹膜炎引起患者拔管转永久血透治疗,21例次(5.7%)的腹膜炎导致患者死亡。难治性腹膜炎患者的超滤能力(4 h-UF)较腹膜炎发生前明显减少(330比270 ml,P=0.036),4 h D/Pcr较腹膜炎发生略有前升高[(0.55±0.08)比(0.58±0.10),P=0.086]。 结论 腹透相关性腹膜炎是导致腹透技术失败及患者死亡的重要原因,难治性腹膜炎可损害患者腹膜功能。
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[5] |
Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were established showing the poor prognosis in some diseases, such as cardiovascular diseases and malignancies. The risk of mortality in patients with end-stage renal disease (ESRD) was higher than normal population. In this study, we aimed to investigate the relationship between NLR, PLR, and all-cause mortality in prevalent hemodialysis (HD) patients.Eighty patients were enrolled in study. NLR and PLR obtained by dividing absolute neutrophil to absolute lymphocyte count and absolute platelet count to absolute lymphocyte count, respectively. The patients were followed prospectively for 24 months. The primary end point was all-cause mortality.Mean levels of neutrophil, lymphocyte, and platelet were 3904 ± 1543/mm(3), 1442 ± 494/mm(3), 174 ± 56 × 10(3)/mm(3), respectively. Twenty-one patients died before the follow-up at 24 months. Median NLR and PLR were 2.52 and 130.4, respectively. All-cause mortality was higher in patients with high NLR group compared to the patients with low NLR group (18.8 vs. 7.5 %, p = 0.031) and in patients with higher PLR group compared to patients with lower PLR group (18.8 vs. 7.5 %, p = 0.022). Following adjusted Cox regression analysis, the association of mortality and high NLR was lost (p = 0.54), but the significance of the association of high PLR and mortality increased (p = 0.013).Although both NLR and PLR were associated with all-cause mortality in prevalent HD patients, only PLR could independently predict all-cause mortality in these populations.
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[6] |
Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been previously suggested as oncologic prognostication markers. These are associated with malnutrition and inflammation, and hence, may provide benefit in predicting mortality among hemodialysis patients.Among 108,548 incident hemodialysis patients in a large U.S. dialysis organization (2007-2011), we compared the mortality predictability of NLR and PLR with baseline and time-varying covariate Cox models using the receiver operating characteristic curve (AUROC), net reclassification index (NRI), and adjusted R2.During the median follow-up period of 1.4 years, 28,618 patients died. Median (IQR) NLR and PLR at baseline were 3.64 (2.68-5.00) and 179 (136-248) respectively. NLR was associated with higher mortality, which appeared stronger in the time-varying versus baseline model. PLR exhibited a J-shaped association with mortality in both models. NLR provided better mortality prediction in addition to demographics, comorbidities, and serum albumin; ΔAUROC and NRI for 1-year mortality (95% CI) were 0.010 (0.009-0.012) and 6.4% (5.5-7.3%) respectively. Additionally, adjusted R2 (95% CI) for the Cox model increased from 0.269 (0.262-0.276) to 0.283 (0.276-0.290) in the non-time-varying model and from 0.467 (0.461-0.472) to 0.505 (0.500-0.512) in the time-varying model. There was little to no benefit of adding PLR to predict mortality.High NLR in incident hemodialysis patients predicted mortality, especially in the short-term period. NLR, but not PLR, added modest benefit in predicting mortality along with demographics, comorbidities, and serum albumin, and should be included in prognostication approaches.© 2017 S. Karger AG, Basel.
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[7] |
Neutrophil-to-lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in end-stage renal disease (ESRD) patients. Recently, platelet-to-lymphocyte ratio (PLR) and NLR were found to positively correlated with inflammatory markers including tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 in cardiac and noncardiac patients. Data regarding PLR and its association with inflammation are lacking in hemodialysis (HD) and peritoneal dialysis (PD) patients. Hence, we aimed to determine the relationship between PLR, NLR, and inflammation in ESRD patients. This was a cross-sectional study involving 62 ESRD patients (29 females, 33 males; mean age, 49.6 ± 14.6 years) receiving PD or HD for ≥6 months in the Dialysis Unit of Necmettin Erbakan University. PLR, NLR, C-reactive protein, TNF-α, IL-6 levels were measured. PLR, NLR, serum high sensitive C-reactive protein, IL-6, and TNF-α levels were significantly higher in PD patients when compared with HD patients. ESRD patients with PLR ≥ 140 had significantly higher NLR, IL-6, and TNF-α levels when compared to patients with PLR < 139. In the bivariate correlation analysis, PLR was positively correlated with NLR, IL-6, and TNF-α in this population. When we compared the association of PLR and NLR with IL-6 (r = 0.371, P = 0.003 vs. r = 0.263, P = 0.04, respectively) and TNF-α (r = 0.334, P = 0.008 vs. r = 0.273, P = 0.032, respectively), PLR was found to be superior to NLR in terms of inflammation in ESRD patients. Simple calculation of PLR can predict inflammation better than NLR in ESRD patients. © 2013 The Authors. Hemodialysis International © 2013 International Society for Hemodialysis.
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[8] |
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[9] |
赖玮婧, 何可, 高芳, 等. 频发腹膜透析相关性腹膜炎的危险因素分析[J]. 四川大学学报(医学版), 2019, 50(2): 264-267. DOI: 10.13464/j.scuxbyxb.2019.02.025.
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[10] |
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[11] |
To evaluate the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and inflammation in end-stage renal disease (ESRD) patients on maintenance hemodialysis (HD).100 ESRD patients on maintenance HD (mean ± SD age: 52.3 ± 1.7 years, 52% were males) were included in this cross-sectional study. Data on patient demographics, dry weight, body mass index, duration of HD (months), etiology of ESRD, delivered dose of dialysis (spKt/V), complete blood count, blood biochemistry and inflammatory markers including hs-CRP (mg/L), TNF-α (pg/mL), NLR, and PLR were recorded in all patients and compared in patients with hs-CRP levels of ≤ 3 mg/L vs. > 3 mg/L. other study parameters were also recorded.Compared to patients with lower hs-CRP levels, patients with hs-CRP levels of > 3 mg/L had significantly higher values for NLR (3.7 ± 0.2 vs. 2.7 ± 0.2, p < 0.01) and PLR (150.7 ± 6.9 vs. 111.8 ± 7.0, p < 0.001). Both NLR and PLR were positively correlated with hs-CRP (r = 0.333, p = 0.01 and r = 0.262, p = 0.001, respectively) and negatively correlated with transferrin saturation (%) (r = -0.418, p = 0.001 and r = -0.309, p = 0.002, respectively).Our findings in a cohort of ESRD patients on maintenance HD revealed higher values for NLR and PLR in patients with higher levels of inflammation along with a significant positive correlation of both NLR and PLR with hs-CRP levels. Being a simple, relatively inexpensive and universally available method, whether or not calculation of NLR and PLR offers a plausible strategy in the evaluation of inflammation in ESRD patients in the clinical practice should be addressed in larger scale randomized and controlled studies.
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[12] |
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[13] |
To investigate the causes of peritonitis in patients with peritoneal dialysis (PD) using continuous quality improvement (CQI) to develop effective interventions and reduce the occurrence of peritonitis.A quality control team consisting of 10 members, including the department head, four nephrologists and four nurses, all specialized in PD care, and the head nurse, was established at the Peritoneal Dialysis Center of the Third Xiangya Hospital of Central South University. All patients with peritonitis occurring between 1 July 2010 and 31 December 2011 (pre-CQI period) were analyzed and compared with data obtained between January 2012 (implementation of CQI) and March 2013 to investigate possible causes of peritonitis and to develop corresponding interventions. Fishbone analysis, including laboratory parameters, was carried out monthly.Gastrointestinal tract dysfunction, nonstandard procedures and malnutrition were found to be the top three risk factors for peritonitis. Gastrointestinal tract dysfunction was the likely cause of peritonitis in 42.8% of the subjects before CQI and 36.0% after CQI (p<0.05). Nonstandard procedures were the cause of peritonitis in 33.3% of the subjects before CQI and 24.0% after CQI (p<0.05). The overall incidence of peritonitis reduced from once every 40.1 patient months before the CQI to once every 70.8 patient months after CQI (p<0.05). The incidence of Gram-positive bacteria peritonitis reduced from once every 96.9 patients per month before CQI to once every 209.1 patient months after CQI (p<0.05), whereas the incidence of Gram-negative bacteria peritonitis reduced from once every 234.2 patient months before CQI to once every 292.8 patient months after CQI.CQI can effectively reduce the occurrence of PD-related peritonitis.
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[14] |
胡杉杉, 周朝敏, 李倩, 等. 血小板/淋巴细胞、中性粒细胞/淋巴细胞比值与血液透析患者蛋白质能量消耗的关系[J]. 中华医学杂志, 2019, 99(8): 587-592. DOI: 10.3760/cma.j.issn.0376-2491.2019.08.005.
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[15] |
詹秋楠, 陈晓莉, 李丹丹, 等. 中性粒细胞与淋巴细胞比值在腹膜透析相关性感染中的临床意义[J]. 中国血液净化, 2018, 17(7): 446-449. DOI: 10.3969/j.issn.1671-4091.2018.07.004.
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