Division of Infectious Diseases (Department of Medicine), Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Avda. Reyes Católicos, 2, 28040 Madrid, Spain.
Eur J Clin Microbiol Infect Dis. 2010 Oct;29(10):1271-5. doi: 10.1007/s10096-010-0998-8. Epub 2010 Jun 13.
The purposes of this paper was to discover whether cirrhosis is a predisposing cause of infectious endocarditis (IE) and to determine the microbiology, prognosis and the role of cardiac surgery on mortality. A review of cases of IE at a university-affiliated hospital over a period of 10 years was conducted. Thirty-one (9.8%) patients among 316 cases of IE had hepatic cirrhosis. Valve disorders were present in 62.2% of cirrhotic patients and infection occurred on the aortic (48%) and mitral valves (45%). Endocarditis was hospital-acquired in 14 (45%) and 11 (17.7%) cirrhotic patients and controls, respectively (odds ratio [OR] 3.82; 95% confidence interval [CI]: 1.46-9.99; p = 0.005). Staphylococcus aureus was the most common causative microorganism, but β-hemolytic streptococci were most frequently isolated in cirrhotic patients (OR 8.75; 95% CI: 1.7-45.2; p = 0.001). Renal failure was more frequent in patients with cirrhosis (OR 8.23; 95% CI: 3.06-22.2; p = 0.001). Cirrhotic patients had a higher mortality (51% vs. 17.7%; OR 4.95; 95% CI: 1.89-12.91; p = 0.001) associated with the severity of liver disease. Valve replacement was performed less frequently in cirrhotic patients (56.2% vs. 92%) and the operative mortality was extremely high in patients at stages B and C. Hepatic cirrhosis is a frequent comorbid condition in patients with endocarditis. Due to the presence of severe hepatic dysfunction, cardiac surgery is not undertaken even when indicated and mortality is high in stages B and C. Endocarditis is a serious hazard for hospitalized cirrhotic patients.
本文旨在探讨肝硬化是否为感染性心内膜炎（IE）的易患因素，并确定微生物学、预后以及心脏手术对死亡率的作用。对某大学附属医院 10 年间的 IE 病例进行了回顾性分析。在 316 例 IE 患者中，有 31 例（9.8%）患有肝硬化。在肝硬化患者中，瓣膜疾病的发生率为 62.2%，感染发生在主动脉瓣（48%）和二尖瓣（45%）。14 例（45%）和 11 例（17.7%）肝硬化患者和对照组的 IE 分别为医院获得性（比值比 [OR] 3.82；95%置信区间 [CI]：1.46-9.99；p=0.005）。金黄色葡萄球菌是最常见的病原体，但β溶血性链球菌在肝硬化患者中最常被分离（OR 8.75；95%CI：1.7-45.2；p=0.001）。肝硬化患者更易发生肾功能衰竭（OR 8.23；95%CI：3.06-22.2；p=0.001）。肝硬化患者的死亡率更高（51% vs. 17.7%；OR 4.95；95%CI：1.89-12.91；p=0.001），这与肝脏疾病的严重程度有关。与对照组相比，行瓣膜置换术的肝硬化患者较少（56.2% vs. 92%），且 B 期和 C 期患者的手术死亡率极高。肝硬化是心内膜炎患者常见的合并症。由于严重的肝功能障碍，即使有手术指征也不进行心脏手术，B 期和 C 期患者的死亡率很高。对于住院的肝硬化患者，心内膜炎是一个严重的危害。
