Omari B, Shapiro S, Ginzton L, Robertson J M, Ward J, Nelson R J, Bayer A S
Department of Surgery, Harbor-UCLA Medical Center, Torrance.
Chest. 1989 Dec;96(6):1273-9. doi: 10.1378/chest.96.6.1273.
The study objective is to identify clinical, microbiologic, and/or echocardiographic risk factors present early in the course of native valve endocarditis that predict subsequent development of periannular extension of infection. A multivariate computer-generated analysis of 21 clinical-microbiologic parameters and 11 two-dimensional echocardiographic parameters in patients with native valve endocarditis was designed. These parameters were statistically compared in operated-on patients with native valve endocarditis with and without periannular extension of infection. The study took place in a 600-bed acute-care, nonreferral, municipal hospital primarily servicing an indigent patient population. Seventy-three documented episodes of native valve endocarditis occurred between the years of 1973 and 1987, including 29 operated-on patients with surgically confirmed periannular extension of infection and 44 operated-on patients without periannular extension of infection. Multivariate logistic-regression analyses of multiple clinical, microbiologic, and echocardiographic parameters which are potentially predictive of eventual periannular extension of native valve endocarditis were carried out. The only two independent parameters that significantly predicted periannular infection among patients with native valve endocarditis were (1) aortic valve involvement and (2) abuse of intravenous (IV) drugs (p less than 0.01; p less than 0.01, respectively, multivariate analysis). The relative risk of developing periannular extension of endocarditis among patients with aortic valve involvement and/or IV drug abuse was increased by approximately 2.5-fold compared with patients without these characteristics. Factors not significantly associated with increased risk of periannular extension of native valve endocarditis included the following: prolonged febrile morbidity; Staphylococcus aureus etiology; or two-dimensional echocardiographic demonstration of vegetations, large vegetations (greater than or equal to 1 cm), multiple vegetations, or enlargement of aortic root or annulus. These data suggest that patients with native aortic valve endocarditis, particularly in the setting of IV drug abuse, should be considered for routine, serial noninvasive evaluation for the early detection of periannular extension of their infection.
本研究的目的是确定在自体瓣膜心内膜炎病程早期出现的、可预测随后感染瓣周扩展发生的临床、微生物学和/或超声心动图危险因素。设计了一项对自体瓣膜心内膜炎患者的21项临床-微生物学参数和11项二维超声心动图参数进行多变量计算机分析。对有或无感染瓣周扩展的接受手术治疗的自体瓣膜心内膜炎患者的这些参数进行了统计学比较。该研究在一家拥有600张床位的急性护理、非转诊市级医院进行，主要服务贫困患者群体。1973年至1987年间记录了73例自体瓣膜心内膜炎发作，包括29例经手术证实有感染瓣周扩展的接受手术治疗的患者和44例无感染瓣周扩展的接受手术治疗的患者。对可能预测自体瓣膜心内膜炎最终瓣周扩展的多个临床、微生物学和超声心动图参数进行了多变量逻辑回归分析。在自体瓣膜心内膜炎患者中，仅有的两个显著预测瓣周感染的独立参数是：（1）主动脉瓣受累和（2）静脉药物滥用（多变量分析中，p均小于0.01）。与无这些特征的患者相比，主动脉瓣受累和/或静脉药物滥用患者发生心内膜炎瓣周扩展的相对风险增加了约2.5倍。与自体瓣膜心内膜炎瓣周扩展风险增加无显著相关的因素包括：发热病程延长；金黄色葡萄球菌病因；或二维超声心动图显示赘生物、大赘生物（≥1 cm）、多个赘生物，或主动脉根部或瓣环扩大。这些数据表明，对于患有自体主动脉瓣心内膜炎的患者，尤其是在静脉药物滥用情况下，应考虑进行常规的系列非侵入性评估，以便早期发现其感染的瓣周扩展。
