血液透析患者感染性心内膜炎的预后因素：来自国家多中心登记处的病例系列

Prognostic factors of infective endocarditis in patients on hemodialysis: A case series from a National Multicenter Registry.

作者信息

Ramos-Martínez Antonio, Roque Fernado, Fariñas Maria Carmen, Muñoz Patricia, Verde Eduardo, Cuerpo Gregorio Pablo, de Alarcón Arístides, Lepe José Antonio, Miró José María, Plata Antonio, Goenaga Miguel Ángel, García-Rosado Dácil, Martínez-Monzonis Amparo, de la Torre Javier, García-Pavía Pablo

机构信息

Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.

Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.

出版信息

Int J Cardiol. 2017 Aug 15;241:295-301. doi: 10.1016/j.ijcard.2017.04.086. Epub 2017 Apr 29.

DOI:10.1016/j.ijcard.2017.04.086

PMID:28487153

Abstract

BACKGROUND

Infective endocarditis (IE) is a severe complication associated with high mortality.

OBJECTIVES

To examine the clinical characteristics of IE in hemodialysis (HD) patients and to determine prognostic factors related to HD.

METHODS

From January 2008 to April 2015, 2488 consecutive patients with definite IE were included. Clinical characteristics of IE patients on HD were compared with those of IE patients who were not on HD.

RESULTS

A total of 126 patients (63% male, median age: 66years; IQR: 54-74years) with IE (5.1%) were on HD. Fifty-two patients died during hospitalization (41%) and 17 additional patients (14%) died during the first year. The rate of patients who underwent surgery during hospitalization was lower in HD patients (38 patients, 30%) than in non-HD patients (1177 patients, 50%; p<0.001). Age >70years (OR: 4.1, 95% CI: 1.7-10), heart failure (OR: 3.3, 95% CI: 1.4-7-6), central nervous system (CNS) vascular events (OR: 6.7, 95% CI: 2.1-22) and septic shock (OR: 4.1, 95% CI: 1.4-12.1) were independently associated with fatal outcome in HD patients. Of the 38 patients who underwent surgery, 15 (39.5%) died during hospitalization.

CONCLUSIONS

HD patients with IE present a high mortality. Advanced age and complications, such as heart failure, CNS stroke or septic shock, are associated with mortality.

摘要

背景

感染性心内膜炎（IE）是一种严重并发症，死亡率很高。

目的

研究血液透析（HD）患者IE的临床特征，并确定与HD相关的预后因素。

方法

纳入2008年1月至2015年4月期间连续收治的2488例确诊IE患者。比较HD患者与非HD患者IE的临床特征。

结果

共有126例（63%为男性，中位年龄：66岁；四分位间距：54 - 74岁）IE患者（占5.1%）接受HD治疗。52例患者（41%）住院期间死亡，另有17例患者（14%）在第一年死亡。HD患者住院期间接受手术的比例（38例，30%）低于非HD患者（1177例，50%；p<0.001）。年龄>70岁（比值比：4.1，95%置信区间：1.7 - 10）、心力衰竭（比值比：3.3，95%置信区间：1.4 - 7.6）、中枢神经系统（CNS）血管事件（比值比：6.7，95%置信区间：2.1 - 22）和感染性休克（比值比：4.1，95%置信区间：1.4 - 12.1）与HD患者的致命结局独立相关。在接受手术的38例患者中，15例（39.5%）住院期间死亡。