Division of Cardiology, Department of Cardiovascular Medicine, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany,
Infection. 2015 Jun;43(3):287-95. doi: 10.1007/s15010-014-0715-0. Epub 2015 Jan 10.
To identify factors associated with short-term, intermediate and long-term outcome in patients with infective endocarditis (IE) and the need for treatment on intensive care unit (ICU).
Retrospective analysis and long-term follow-up by questionnaire in the two medical ICUs of our university hospital.
We conducted a retrospective analysis of all consecutive patients with IE and need for ICU treatment in our department between 2002 and 2009. All patients fulfilled the modified Duke criteria for definite diagnosis of IE.
Data of 216 patients (aged 62 ± 14 years, 31 % female) were analyzed, 15.7 % of whom had prosthetic valve endocarditis. Infectious agent (IA) was identified in 74 % and surgery was performed in 57 %. 56 patients (24.9 %) died on ICU, 9 patients were sent to palliative care units and died several days later. During follow-up, another 44 patients died. Multivariate Cox-regression analysis identified the following independent risk factors: High initial SAPS II for 30d-, multiple organ failure and high maximum SAPS II for 100d- and high maximum leukocyte count for long-term mortality. Surgical intervention during ICU was an independent predictor of a better 30d outcome.
In contrast to general IE populations, IA and the type of infected impaired valve are not main predictors of survival in critically ill IE-patients. Biomarker of acute infection and markers for severity of illness (scores and organ failure) are independent risk factors for mortality. The surgical clearance of infected valve, device or abscesses is an independent predictor of 30d outcome.
确定感染性心内膜炎（IE）患者短期、中期和长期预后的相关因素，以及在重症监护病房（ICU）治疗的需求。
我们对 2002 年至 2009 年期间我院两个医学 ICU 中连续因 IE 且需要 ICU 治疗的所有患者进行回顾性分析和长期随访，采用问卷调查的方式。
我们对我院心内科连续因 IE 且需要 ICU 治疗的所有患者进行回顾性分析，所有患者均符合改良的 Duke 标准以明确 IE 诊断。
共分析了 216 例患者（年龄 62 ± 14 岁，31%为女性）的数据，其中 15.7%为人工瓣膜心内膜炎。74%的患者明确了感染病原体，57%的患者进行了手术。56 例（24.9%）患者在 ICU 死亡，9 例患者被送往姑息治疗病房，几天后死亡。随访期间，又有 44 例患者死亡。多变量 Cox 回归分析确定了以下独立危险因素：30d 时初始 SAPS II 高、多器官衰竭和 100d 时最大 SAPS II 高以及白细胞计数高与长期死亡率相关。在 ICU 期间进行手术干预是 30d 结局较好的独立预测因素。
与一般 IE 人群不同，在危重症 IE 患者中，感染病原体和感染受损瓣膜的类型不是生存的主要预测因素。急性感染的生物标志物和疾病严重程度的标志物（评分和器官衰竭）是死亡的独立危险因素。清除受感染的瓣膜、器械或脓肿是 30d 结局的独立预测因素。
