Karth Georg, Koreny Maria, Binder Thomas, Knapp Sylvia, Zauner Christian, Valentin Andreas, Honninger Rosemarie, Heinz Gottfried, Siostrzonek Peter
Resident, Department of Cardiology, University of Vienna, Austria.
Crit Care. 2002 Apr;6(2):149-54. doi: 10.1186/cc1474. Epub 2002 Mar 6.
To study incidence, clinical course and prognostic factors in patients admitted to medical intensive care units (ICUs) because of a complicated course of infective endocarditis.
This was a retrospective multicenter observational study of 4106 patients admitted to four medical ICUs in one tertiary hospital and one university hospital between 1994 and 1999.
Infective endocarditis was identified in 33 (0.8%) patients. Of these, 26 were male, mean age was 59 +/- 12 and APACHE-III score was 75 +/- 31. Reasons for transfer to the ICU were congestive heart failure in 64%, septic shock in 21%, neurological deterioration in 15% and cardiopulmonary resuscitation in 9%. Inotropes or vasoconstrictors were required in 73% and multiorgan failure developed in 64% of the patients. Prosthetic valve endocarditis was present in 21%. Gram-positive cocci were found in 96% of all positive cultures; cultures were negative in 27% of the patients. Transthoracic echocardiograms were diagnostic in only 33% and transesophageal studies were required in 91% to confirm diagnosis or fully to delineate the extent of disease. Surgical intervention was performed in 60% of the patients, and the remaining 40% were only treated medically. The APACHE-III score on admission did not differ statistically between the two groups (69 +/- 30 versus 84 +/- 34, P = 0.17). In-patient mortality was 84% in patients treated medically, and 35% in surgically treated patients. Using multivariate analysis, acute renal failure on admission was identified as the independent single predictor for in-patient death (OR 5, 95% CI 1.04-24.03, P = 0.04).
The prognosis for patients with infective endocarditis requiring admission to a medical ICU is serious. Nevertheless, the data suggest that surgical intervention may be successfully performed in a substantial number of patients despite the presence of severe shock and occurrence of multiorgan failure.
研究因感染性心内膜炎复杂病程而入住内科重症监护病房（ICU）患者的发病率、临床病程及预后因素。
这是一项对1994年至1999年间在一家三级医院和一家大学医院的四个内科ICU收治的4106例患者进行的回顾性多中心观察性研究。
在33例（0.8%）患者中确诊为感染性心内膜炎。其中，男性26例，平均年龄59±12岁，急性生理与慢性健康状况评分系统III（APACHE-III）评分为75±31分。转入ICU的原因：充血性心力衰竭占64%，感染性休克占21%，神经功能恶化占15%，心肺复苏占9%。73%的患者需要使用血管活性药物或血管收缩剂，64%的患者发生多器官功能衰竭。人工瓣膜心内膜炎占21%。所有阳性培养物中96%发现革兰氏阳性球菌；27%的患者培养结果为阴性。经胸超声心动图仅33%具有诊断价值，91%的患者需要经食管超声心动图检查以确诊或全面评估疾病范围。60%的患者接受了手术干预，其余40%仅接受药物治疗。两组患者入院时的APACHE-III评分在统计学上无差异（69±30与84±34，P = 0.17）。药物治疗患者的住院死亡率为84%，手术治疗患者为35%。多因素分析显示，入院时急性肾衰竭是住院死亡的独立单一预测因素（比值比5，95%可信区间1.04 - 24.03，P = 0.04）。
因感染性心内膜炎需入住内科ICU的患者预后严重。然而，数据表明，尽管存在严重休克和多器官功能衰竭，仍有相当数量的患者可成功接受手术干预。
