感染性心内膜炎的长期预后：一项对芬兰一家教学医院在25年间接受治疗的初次发作后存活超过一年的患者的研究。

Long-term outcome of infective endocarditis: a study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years.

作者信息

Heiro Maija, Helenius Hans, Hurme Saija, Savunen Timo, Metsärinne Kaj, Engblom Erik, Nikoskelainen Jukka, Kotilainen Pirkko

机构信息

Department of Medicine, Turku University Hospital, Turku, Finland.

出版信息

BMC Infect Dis. 2008 Apr 17;8:49. doi: 10.1186/1471-2334-8-49.

DOI:10.1186/1471-2334-8-49

PMID:18419812

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2383901/

Abstract

BACKGROUND

Only a few previous studies have focused on the long-term prognosis of the patients with infective endocarditis (IE). Our purpose was to delineate factors potentially associated with the long-term outcome of IE, recurrences of IE and requirement for late valve surgery.

METHODS

A total of 326 episodes of IE in 303 patients were treated during 1980-2004 in the Turku University Hospital. We evaluated the long-term outcome and requirement for late valve surgery for 243 of these episodes in 226 patients who survived longer than 1 year after the initial admission. Factors associated with recurrences were analysed both for the 1-year survivors and for all 303 patients.

RESULTS

The mean (SD) follow-up time for the 1-year survivors was 11.5 (7.3) years (range 25 days to 25.5 years). The overall survival was 95%, 82%, 66%, 51% and 45% at 2, 5, 10, 15 and 20 years. In age and sex adjusted multivariate analyses, significant predictors for long-term overall mortality were heart failure within 3 months of admission (HR 1.97, 95% CI 1.27 to 3.06; p = 0.003) and collagen disease (HR 2.54, 95% CI 1.25 to 5.19; p = 0.010) or alcohol abuse (HR 2.39, 95% CI 1.30 to 4.40; p = 0.005) as underlying conditions, while early surgery was significantly associated with lower overall mortality rates (HR 0.31, 95% CI 0.17 to 0.58; p < 0.001). Heart failure was also significantly associated with the long-term cardiac mortality (p = 0.032). Of all 303 patients, 20 had more than 1 disease episode. Chronic dialysis (p = 0.002), intravenous drug use (p = 0.002) and diabetes (p = 0.015) were significant risk factors for recurrent episodes of IE, but when analysed separately for the 1-year survivors, only chronic dialysis remained significant (p = 0.017). Recurrences and late valve surgery did not confer a poor prognosis.

CONCLUSION

Heart failure during the index episode of IE was the complication, which significantly predicted a poor long-term outcome. Patients who underwent surgery during the initial hospitalisation for IE faired significantly better than those who did not.

摘要

背景

以往仅有少数研究关注感染性心内膜炎（IE）患者的长期预后。我们的目的是明确可能与IE长期预后、IE复发以及晚期瓣膜手术需求相关的因素。

方法

1980年至2004年期间，图尔库大学医院共治疗了303例患者的326次IE发作。我们评估了226例初始入院后存活超过1年的患者中243次发作的长期预后和晚期瓣膜手术需求。对1年幸存者和所有303例患者分析了与复发相关的因素。

结果

1年幸存者的平均（标准差）随访时间为11.5（7.3）年（范围25天至25.5年）。2年、5年、10年、15年和20年时的总生存率分别为95%、82%、66%、51%和45%。在年龄和性别校正的多变量分析中，入院后3个月内出现心力衰竭（HR 1.97，95%CI 1.27至3.06；p = 0.003）以及潜在疾病为胶原病（HR 2.54，95%CI 1.25至5.19；p = 0.010）或酒精滥用（HR 2.39，95%CI 1.30至4.40；p = 0.005）是长期总死亡率的显著预测因素，而早期手术与较低的总死亡率显著相关（HR 0.31，95%CI 0.17至0.58；p < 0.001）。心力衰竭也与长期心脏死亡率显著相关（p = 0.032）。在所有303例患者中，20例有不止1次发病。慢性透析（p = 0.002）、静脉吸毒（p = 0.002）和糖尿病（p = 0.015）是IE复发的显著危险因素，但对1年幸存者单独分析时，只有慢性透析仍然显著（p = 0.017）。复发和晚期瓣膜手术并未导致不良预后。