Anguera Ignasi, Miro Jose M, Cabell Christopher H, Abrutyn Elias, Fowler Vance G, Hoen Bruno, Olaison Lars, Pappas Paul A, de Lazzari Elisa, Eykyn Susannah, Habib Gilbert, Pare Carles, Wang Andrew, Corey Ralph
The Corporació Sanitària Parc Taulí, Hospital de Sabadell, University of Barcelona, Barcelona, Spain.
Am J Cardiol. 2005 Oct 1;96(7):976-81. doi: 10.1016/j.amjcard.2005.05.056.
The aims of this study were to determine the clinical characteristics and outcome of patients who had definite infective endocarditis (IE) complicated by aortic ring abscess formation that was detected with transesophageal echocardiography (TEE) and to determine the prognostic significance of abscess formation in aortic valve IE. Patients who had aortic valve IE were selected from the International Collaboration on Endocarditis Merged Database (ICE-MD) if they underwent TEE. Among 311 patients who had definite aortic valve IE, 67 (22%) had periannular abscesses. They were more likely to have infection in the setting of a prosthetic valve (40% vs 19%, p <0.001) and coagulase-negative staphylococcal IE (18% vs 6%, p < 0.01) and less likely to have streptococcal IE than were patients who did not develop abscess (28% vs 46%, p = 0.01). Systemic embolization, central nervous system events, and heart failure did not differ between those who developed abscess and those who did not, but power was limited. Patients who had abscess were more likely to undergo surgery (84% vs 36%, p <0.001), and their in-hospital mortality rate was higher (19% vs 11%, p = 0.09). Multivariate analysis of prognostic factors of mortality in aortic IE identified age (odds ratio [OR] 1.6, 95% confidence interval [CI]1.2 to 2.1), Staphylococcus aureus (S. aureus) infection (OR 2.4, 95% CI 1.1 to 5.2), and heart failure (OR 2.9, 95% CI 1.4 to 6.1) as variables that were independently associated with increased risk of death. Periannular abscess formation showed a nonsignificant trend toward an increased risk of death (OR 1.9, 95% CI 0.9 to 3.8). Multivariate analysis of prognostic factors of mortality in complicated aortic IE with abscess formation identified S. aureus infection (OR 6.9, 95% CI 1.6 to 29.4) as independently associated with increased risk of death. In conclusion, in the current era of TEE and high use of surgical treatment, periannular abscess formation in aortic valve IE is not an independent risk factor for mortality. S. aureus infection is an independent prognostic factor for mortality in patients who have abscess formation.
本研究的目的是确定经食管超声心动图（TEE）检测到合并主动脉环脓肿形成的确诊感染性心内膜炎（IE）患者的临床特征和预后，并确定主动脉瓣IE中脓肿形成的预后意义。如果主动脉瓣IE患者接受了TEE检查，则从国际心内膜炎合并数据库（ICE-MD）中选取。在311例确诊为主动脉瓣IE的患者中，67例（22%）有瓣周脓肿。与未发生脓肿的患者相比，他们更有可能在人工瓣膜置入情况下发生感染（40%对19%，p<0.001）以及凝固酶阴性葡萄球菌性IE（18%对6%，p<0.01），而链球菌性IE的可能性较小（28%对46%，p = 0.01）。发生脓肿和未发生脓肿的患者在全身栓塞、中枢神经系统事件和心力衰竭方面无差异，但检验效能有限。有脓肿的患者更有可能接受手术（84%对36%，p<0.001），且其住院死亡率更高（19%对11%，p = 0.09）。对主动脉IE死亡率的预后因素进行多变量分析，确定年龄（比值比[OR]1.6，95%置信区间[CI]1.2至2.1）、金黄色葡萄球菌（S. aureus）感染（OR 2.4，95%CI 1.1至5.2）和心力衰竭（OR 2.9，95%CI 1.4至6.1）为与死亡风险增加独立相关的变量。瓣周脓肿形成显示出死亡风险增加的趋势，但无统计学意义（OR 1.9，95%CI 0.9至3.8）。对合并脓肿形成的复杂性主动脉IE死亡率的预后因素进行多变量分析，确定金黄色葡萄球菌感染（OR 6.9，95%CI 1.6至29.4）为与死亡风险增加独立相关的因素。总之，在当前TEE及手术治疗广泛应用的时代，主动脉瓣IE中的瓣周脓肿形成并非死亡的独立危险因素。金黄色葡萄球菌感染是有脓肿形成患者死亡的独立预后因素。
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