Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria.
Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria.
Int J Cardiol. 2018 Feb 1;252:74-79. doi: 10.1016/j.ijcard.2017.10.085. Epub 2017 Nov 7.
Pediatric infective endocarditis (IE) has been associated with high morbidity and mortality, mostly related to thromboembolic complications (TEC). The objective of our study was to describe the experience in children with IE and to review the changes over a thirty-year period, regarding origin of IE, incidence of vegetations, TEC and their respective morbidity and mortality rates.
A retrospective chart review of children aged 0-18years with IE defined by the Duke Criteria and admitted to The Hospital for Sick Children, was conducted. Data were divided into three periods (P); P1 (1979-1988); P2 (1989-1998); and P3 (1999-2008).
The study included 113 patients, median age 7yrs.; females: 46 (41%), congenital heart defects 95 (84%), comparable in all periods. Overall, cardiac vegetations were found in 68/113 patients (60%); large vegetations (≥1cm) in 32 patients (28%). Fourty-five (45/133 [40%]) TEC were documented, 22 patients (20%) developed cerebrovascular events (CVE) and 23 patients (20%) had non-CVE. Patients diagnosed during P3 were older, had more vegetations (p<0.05), and a higher incidence of community acquired-IE (p<0.05). Overall, mortality was 15%, comparable in all periods. Significant risk factors for mortality were vegetations (HR 6.44; 95% CI: 2.07-20.01, p=0.002) and heart failure (HR 28.39; 95% CI: 10.49-76.85, p<0.001).
Over the study period, we report a growing incidence of community acquired pediatric IE in older children accompanied by an increasing rate of TEC. Heart failure and vegetations were associated with an increased mortality. These preliminary data need to be confirmed by prospective data.
小儿感染性心内膜炎（IE）与高发病率和死亡率相关，主要与血栓栓塞并发症（TEC）有关。本研究的目的是描述小儿 IE 的经验，并回顾三十年来的变化，包括 IE 的起源、赘生物的发生率、TEC 及其各自的发病率和死亡率。
对在多伦多 SickKids 医院就诊的符合 Duke 标准的 0-18 岁小儿 IE 患者进行回顾性病历分析。数据分为三个时期（P）：P1（1979-1988 年）；P2（1989-1998 年）；P3（1999-2008 年）。
本研究共纳入 113 例患者，中位年龄为 7 岁，女性占 46 例（41%），先天性心脏病占 95 例（84%），三个时期之间无显著差异。113 例患者中，68 例（60%）发现心脏赘生物，32 例（28%）有大赘生物（≥1cm）。45 例（45/133 [40%]）发生 TEC，22 例（20%）发生脑血管事件（CVE），23 例（20%）发生非 CVE。P3 期诊断的患者年龄较大，赘生物更多（p<0.05），社区获得性 IE 的发病率更高（p<0.05）。总体死亡率为 15%，各时期无显著差异。死亡率的显著危险因素为赘生物（HR 6.44；95%CI：2.07-20.01，p=0.002）和心力衰竭（HR 28.39；95%CI：10.49-76.85，p<0.001）。
在研究期间，我们报告了年长儿童社区获得性小儿 IE 发病率的增加，同时 TEC 发生率也在增加。心力衰竭和赘生物与死亡率的增加有关。这些初步数据需要前瞻性数据加以证实。
