Maraj Suraj, Jacobs Larry E, Kung Shiang-Cheng, Raja Rasib, Krishnasamy Prakash, Maraj Rajiv, Braitman Leonard E, Kotler Morris N
Division of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA.
Am J Med Sci. 2002 Nov;324(5):254-60. doi: 10.1097/00000441-200211000-00004.
Survival in patients with infective endocarditis (IE) ranges from 4 to 50% depending on the type of organism, the type of valve involvement and the type of treatment.
We conducted a retrospective analysis of data in hemodialysis (HD) patients at our center from 1990 to 2000. Demographics, risk factors, and outcome data were extracted in the subgroup of patients with first-episode IE diagnosed primarily by echocardiography.
A total of 2239 patients underwent HD at our center. Thirty-two (1.4%) had IE defined using the Duke Criteria. Permanent and temporary venous dialysis catheters, arteriovenous (AV) grafts, and AV fistulae were used in 19 (59%), 12 (38%), and 1 (3%) patient respectively. Mean access duration was 7.6 +/- 7.9 months. Thirty (94%) patients had positive blood cultures, with the majority having Staphylococcus aureus bacteremia. Two (7%) patients had positive echocardiographic findings but negative blood cultures due to the commencement of empiric antibiotic therapy prior to blood cultures. The mitral valve was mainly affected. Transesophageal echocardiography was performed in 23 (72%) patients and detected an intracardiac mass in all 23 patients. One-year mortality was 56.3%. A poor 1-year prognosis was associated with presenting features of low hemoglobin, elevated leukocyte count, hypoalbuminemia, severe aortic and mitral regurgitation, and annular calcification in mitral valve IE.
The prevalence of IE in HD patients is 1.4%. One-year mortality was 56.3%. Close observation is required during the first year when patients with severe valvular regurgitation and hematological abnormalities have a high mortality.
感染性心内膜炎（IE）患者的生存率在4%至50%之间，这取决于病原体类型、瓣膜受累类型及治疗方式。
我们对本中心1990年至2000年血液透析（HD）患者的数据进行了回顾性分析。在主要通过超声心动图诊断为首发IE的患者亚组中提取人口统计学、危险因素及结局数据。
本中心共有2239例患者接受HD治疗。32例（1.4%）符合IE的杜克标准。分别有19例（59%）、12例（38%）和1例（3%）患者使用了永久性和临时性静脉透析导管、动静脉（AV）移植物及AV内瘘。平均通路使用时间为7.6±7.9个月。30例（94%）患者血培养呈阳性，大多数为金黄色葡萄球菌菌血症。2例（7%）患者超声心动图检查结果阳性但血培养阴性，原因是在血培养前开始了经验性抗生素治疗。二尖瓣受累为主。23例（72%）患者接受了经食管超声心动图检查，所有23例均检测到心内肿块。1年死亡率为56.3%。1年预后不良与血红蛋白低、白细胞计数升高、低白蛋白血症、严重主动脉瓣和二尖瓣反流以及二尖瓣IE中的瓣环钙化等表现有关。
HD患者中IE的患病率为1.4%。1年死亡率为56.3%。对于有严重瓣膜反流和血液学异常的患者，第一年死亡率较高，需要密切观察。
