Abstract: OBJECTIVE To analyze the influencing factors of refractory peritoneal dialysis-associated peritonitis, establish the risk scoring model and provide reference for clinical treatment and prevention.METHODS A total of 129 patients with peritoneal dialysis-associated peritonitis（PDAP） were collected from the blood purification center in Nanjing First Hospital from Apr. 2010 to Feb. 2019. According to the progress of the disease, 30 patients were classified as refractory PDAP and 99 patients as non-refractory PDAP. The clinical baseline data of the two groups were retrospectively collected, and the suspected influencing factors of refractory PDAP were statistically analyzed, and a risk scoring model was established.RESULTS In the 129 patients with PDAP, 30 cases of refractory PDAP occurred, and the incidence rate was 23.26%. 30 strains of pathogens were cultured from the peritoneal dialysis effusion, including 13 strains of Gram-positive bacteria（43.33%）, 10 strains of Gram-negative bacteria（33.33%）, and 7 strains of fungi（23.33%）. Multivariate analysis showed that Gram-negative bacterial infection, complications and CRP levels were independent influencing factors for refractory PDAP（P＜0.05）. Risk scoring model establishment: Gram-negative bacterial infection（2 points）, complications（2 points）, CRP values of 1.34 to 22.6 mg/L, 23.6 to 58.8 mg/L, 62.4 to 123.5 mg/L, 124 to 358 mg/L were set as 0, 1, 2, and 3, respectively. The risk scoring model predicted that the area under the ROC curve of refractory PDAP was 0.778（95% CI: 0.696 to 0.846, P＜0.001）, and the optimal cutoff value was 4 points. The sensitivity and specificity were 60.00% and 91.92%, respectively, and the Yoden index was 0.519.CONCLUSION Gram-negative bacterial infection, complications, and high CRP values are independent influential factors for refractory PDAP. The constructed risk scoring model predicts refractory PDAP with high accuracy, and has a high value in clinical application.