Arshad Sadia, Awan Safia, Bokhari Syedah Saira, Tariq Muhammad
J Pak Med Assoc. 2015 Jan;65(1):3-8.
To evaluate the clinical characteristics and predictors of in-hospital mortality in patients with infective endocarditis at a tertiary care centre in Pakistan.
The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from January 1, 2002, to December 31, 2006, and comprised 84 consecutive patients hospitalised with infective endocarditis,. All patients underwent verification of the diagnosis according to the Modified Duke criterion. Data was collected through a questionnaire and analysed using Student's t test, Chi square and Fisher's exact test. Univariate and multivariate logistic regression analysis was performed to assess predictors of mortality.
Of the total, 53(63%) patients were male and 31(37%) female. The mean age of the patients was 42+17 years. Overall, 34(41%) patients had rheumatic valve disease as a predisposing condition. The most commonly affected valve was mitral in 43(51%) patients, and the most commonly isolated organism was methicillin-resistant staphylococcus aureus in 12(14.3%). Overall in-hospital mortality was 27(32.1%), while 18(21%) patients, developed congestive cardiac failure, 15(18%) developed arrhythmias, 16(19%) developed peripheral embolism and renal failure was present in 38(54%). Besides, 17(20%) patients underwent surgical intervention. The final multivariate model that can be used to predict mortality in this study consisted of the presence of neurological complications (p <0.001) Odds Ratio 7.26, Confidence Interval (2.27-23.18), congestive cardiac heart failure (p <0.023) Odds Ratio 5.39, Confidence Interval (1.26-23.04), and arrhythmias (p <0.034) Odds Ratio 4.21, Confidence Interval (1.11-15.88).
Significant predictors of mortality in hospitalised patients with infective endocarditis in our study were the presence of neurological complications, congestive cardiac heart failure, and the presence of arrhythmias.
评估巴基斯坦一家三级医疗中心感染性心内膜炎患者的临床特征及院内死亡的预测因素。
本横断面研究于2002年1月1日至2006年12月31日在卡拉奇的阿迦汗大学医院进行，纳入84例连续住院的感染性心内膜炎患者。所有患者均根据改良的杜克标准进行诊断核实。通过问卷调查收集数据，并采用学生t检验、卡方检验和费舍尔精确检验进行分析。进行单因素和多因素逻辑回归分析以评估死亡的预测因素。
总共53例（63%）患者为男性，31例（37%）为女性。患者的平均年龄为42±17岁。总体而言，34例（41%）患者有风湿性瓣膜病作为易感因素。最常受累的瓣膜是二尖瓣，有43例（51%）患者，最常见的分离菌是耐甲氧西林金黄色葡萄球菌，有12例（14.3%）。总体院内死亡率为27例（32.1%），18例（21%）患者发生充血性心力衰竭，15例（18%）发生心律失常，16例（19%）发生外周栓塞，38例（54%）存在肾衰竭。此外，17例（20%）患者接受了手术干预。本研究中可用于预测死亡的最终多因素模型包括存在神经系统并发症（p<0.001），比值比7.26，置信区间（2.27 - 23.18），充血性心力衰竭（p<0.023），比值比5.39，置信区间（1.26 - 23.04），以及心律失常（p<0.034），比值比4.21，置信区间（1.11 - 15.88）。
在我们的研究中，住院感染性心内膜炎患者死亡的重要预测因素是存在神经系统并发症、充血性心力衰竭和心律失常。
