Yoshinaga Masao, Niwa Koichiro, Niwa Atsuko, Ishiwada Naruhiko, Takahashi Hideto, Echigo Shigeyuki, Nakazawa Makoto
Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima City, Japan.
Am J Cardiol. 2008 Jan 1;101(1):114-8. doi: 10.1016/j.amjcard.2007.07.054.
Despite developments in preventative and medical therapy, infective endocarditis (IE) carries a high rate of mortality. Risk factors for mortality are unknown in pediatric and adult patients with congenital heart disease (CHD). We determined the risk factors for in-hospital mortality in pediatric and adult patients with CHD. A retrospective observational cohort study was conducted from January 1997 to December 2001 in Japan. Of the 239 patients for whom complete data were available, 216 patients with CHD were identified. Outcomes were alive or deceased. The proposed modified Duke's criteria identified 137 patients, aged 1 month to 62 years with a median of 12 years, with IE. In-hospital mortality was 10%. Four risk factors were independently associated with mortality by stepwise logistic regression analysis: (1) vegetation size > or =20 mm (odds ratio 40.6, 95% confidence interval 2.42 to 681); (2) age <1 year (odds ratio 19.5, 95% confidence interval 1.74 to 219); (3) presence of heart failure (odds ratio 7.16, 95% confidence ratio 1.34 to 38.4); and (4) Staphylococcus aureus as a causative organism (odds ratio 5.68, 95% confidence interval 1.16 to 27.9). Surgical intervention emerged as a predictive factor for lower in-hospital mortality (odds ratio 0.045, 95% confidence interval 0.003 to 0.70) by stepwise logistic regression analysis. In conclusion, surgical intervention, which decreases the risk of in-hospital mortality, should always be considered.
尽管在预防和药物治疗方面取得了进展，但感染性心内膜炎（IE）的死亡率仍然很高。先天性心脏病（CHD）患儿和成人患者的死亡风险因素尚不清楚。我们确定了CHD患儿和成人患者住院死亡率的风险因素。1997年1月至2001年12月在日本进行了一项回顾性观察队列研究。在239例可获得完整数据的患者中，确定了216例CHD患者。结局为存活或死亡。拟议的改良杜克标准确定了137例年龄在1个月至62岁（中位数为12岁）的IE患者。住院死亡率为10%。通过逐步逻辑回归分析，有四个风险因素与死亡率独立相关：（1）赘生物大小≥20mm（比值比40.6，95%置信区间2.42至681）；（2）年龄<1岁（比值比19.5，95%置信区间1.74至219）；（3）存在心力衰竭（比值比7.16，95%置信区间1.34至38.4）；以及（4）金黄色葡萄球菌作为病原体（比值比5.68，95%置信区间1.16至27.9）。通过逐步逻辑回归分析，手术干预成为住院死亡率较低的预测因素（比值比0.045，95%置信区间0.003至0.70）。总之，应始终考虑进行手术干预，以降低住院死亡率。
