Ilhão Moreira Rita, Coutinho Cruz Madalena, Moura Branco Luísa, Galrinho Ana, Coutinho Miranda Luís, Fragata José, Cruz Ferreira Rui
Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Rev Port Cardiol (Engl Ed). 2018 May;37(5):387-394. doi: 10.1016/j.repc.2017.08.007. Epub 2018 May 3.
Infective endocarditis (IE) is associated with high morbidity and mortality. It is important to determine which factors increase the risk of poor outcome in order to enable early detection and aggressive treatment, including surgery. The aim of our study was to identify factors predicting complications and in-hospital mortality in patients with IE and to analyze conditions predisposing to surgery and its outcome.
We performed a retrospective study including patients with IE who underwent transesophageal echocardiography in a tertiary hospital center (2006-2014).
A total of 233 patients were analyzed (69.1% male; mean age 63.4±15.2 years; mean follow-up 28.4±30.7 months). The complication rate was 56.6% and in-hospital mortality was 16.3%. Independent predictors of mortality were chronic obstructive pulmonary disease (OR 4.89; CI 1.36-17.63; p=0.015), clinical course complicated by cerebral embolism (OR 9.38; CI 3.26-26.96; p<0.001), and IE due to Staphylococcus spp. (OR 3.78; CI 1.32-10.85; p=0.014) and non-HACEK Gram-negative bacilli (OR 12.85; CI 2.61-63.23; p=0.002). Surgery was performed in 36.9%. This group had higher percentages of males, younger patients, aortic valve IE, large vegetations, perivalvular extension, severe valvular regurgitation and heart failure. In patients with surgical indication (n=133), those who underwent surgery had lower in-hospital mortality (15.5% vs. 32.6%, p=0.028) and better long-term survival (log-rank p=0.029).
The results of this study may help to identify IE patients who are at increased risk of worse outcome, offering the opportunity to change the course of the disease and to improve prognosis with earlier and more aggressive intervention.
感染性心内膜炎（IE）与高发病率和死亡率相关。确定哪些因素会增加不良预后的风险，以便能够早期发现并进行积极治疗，包括手术治疗，这一点很重要。我们研究的目的是确定预测IE患者并发症和住院死亡率的因素，并分析易导致手术及其结果的情况。
我们进行了一项回顾性研究，纳入了在一家三级医院中心接受经食管超声心动图检查的IE患者（2006 - 2014年）。
共分析了233例患者（男性占69.1%；平均年龄63.4±15.2岁；平均随访28.4±30.7个月）。并发症发生率为56.6%，住院死亡率为16.3%。死亡率的独立预测因素为慢性阻塞性肺疾病（OR 4.89；CI 1.36 - 17.63；p = 0.015）、并发脑栓塞的临床病程（OR 9.38；CI 3.26 - 26.96；p < 0.001）、由葡萄球菌属引起的IE（OR 3.78；CI 1.32 - 10.85；p = 0.014）以及非HACEK革兰氏阴性杆菌引起的IE（OR 12.85；CI 2.61 - 63.23；p = 0.002）。36.9%的患者接受了手术。该组男性、年轻患者、主动脉瓣IE、大赘生物、瓣周扩展、严重瓣膜反流和心力衰竭的比例较高。在有手术指征的患者（n = 133）中，接受手术的患者住院死亡率较低（15.5%对32.6%，p = 0.028），长期生存率更好（对数秩检验p = 0.029）。
本研究结果可能有助于识别预后较差风险增加的IE患者，为改变疾病进程以及通过更早、更积极的干预改善预后提供机会。
