Wallace S M, Walton B I, Kharbanda R K, Hardy R, Wilson A P, Swanton R H
Department of Cardiology, The Middlesex Hospital, University College London Hospitals NHS Trust, London, UK.
Heart. 2002 Jul;88(1):53-60. doi: 10.1136/heart.88.1.53.
To identify clinical markers available within the first 48 hours of admission that are associated with poor outcome in infective endocarditis.
Retrospective cohort study.
Teaching hospital.
208 of 220 patients with infective endocarditis.
Consecutive patients with infective endocarditis presenting between 1981 and 1999 to a tertiary centre were studied. Clinical, echocardiographic, and haematological data recorded within 48 hours of admission were obtained. Data were analysed using logistic regression models.
Mortality at discharge and at six months.
Data were obtained for 93% of patients who were eligible for inclusion. 194 (93%) were positive for Duke criteria. Mean age was 52 (1.2) years, and 138 (66%) were men. 82 (39%) were transferred from other hospitals. 181 (87%) were blood culture positive, and 47 (23%) infections were Staphylococcus aureus. The infection was located on aortic (n = 85, 41%), mitral (n = 77, 37%), tricuspid (n = 18, 9%), and multiple valves (n = 20, 10%). 67 (32%) had prosthetic valve endocarditis. 48% of the cohort were managed with antibiotics alone. Mortality at discharge was 18% and at six months 27%. Duration of illness before admission, age, sex, valve infected, infecting organism, and left ventricular function were not predictors of adverse mortality. However, abnormal white cell count, serum albumin concentration, serum creatinine concentration, or cardiac rhythm, the presence of two major Duke criteria, or visible vegetation conferred a poor prognosis.
Conventional prognostic factors in this study did not appear to predict outcome early during hospital admission. However, simple clinical indices, which are readily available, are reliable, cheap, and potentially powerful predictors of poor outcome.
确定入院后48小时内可获得的、与感染性心内膜炎不良预后相关的临床标志物。
回顾性队列研究。
教学医院。
220例感染性心内膜炎患者中的208例。
对1981年至1999年间在一家三级中心就诊的连续性感染性心内膜炎患者进行研究。获取入院48小时内记录的临床、超声心动图和血液学数据。使用逻辑回归模型进行数据分析。
出院时及六个月时的死亡率。
93%符合纳入标准的患者获得了数据。194例（93%）符合杜克标准。平均年龄为52（1.2）岁，138例（66%）为男性。82例（39%）从其他医院转诊而来。181例（87%）血培养阳性，47例（23%）感染为金黄色葡萄球菌。感染位于主动脉瓣（n = 85，41%）、二尖瓣（n = 77，37%）、三尖瓣（n = 18，9%）和多个瓣膜（n = 20，10%）。67例（32%）患有人工瓣膜心内膜炎。48%的队列仅接受抗生素治疗。出院时死亡率为18%，六个月时为27%。入院前病程、年龄、性别、感染瓣膜、感染病原体和左心室功能不是不良死亡率的预测因素。然而，白细胞计数异常、血清白蛋白浓度、血清肌酐浓度或心律异常、存在两项主要杜克标准或可见赘生物提示预后不良。
本研究中的传统预后因素似乎不能在入院早期预测结局。然而，简单的临床指标易于获得、可靠、廉价且可能是不良结局的有力预测因素。
