Chaudry Mavish S, Gislason Gunnar H, Kamper Anne-Lise, Rix Marianne, Dahl Anders, Østergaard Lauge, Fosbøl Emil L, Lauridsen Trine K, Oestergaard Louise B, Hassager Christian, Torp-Pedersen Christian, Bruun Niels E
Department of Cardiology, Herlev-Gentofte Hospital University of Copenhagen, Post 635 Kildegårdsvej 28, 2900, Hellerup, Denmark.
The National Institute of Public Health, University of Southern Denmark and The Danish Heart Foundation, Copenhagen, Denmark.
BMC Nephrol. 2018 Sep 3;19(1):216. doi: 10.1186/s12882-018-1016-0.
The risk of infective endocarditis (IE) is markedly increased in patients receiving chronic hemodialysis compared with the general population, but outcome data are sparse. The present study investigated causes and risk factors of mortality in a hemodialysis-treated end-stage kidney disease- (ESKD) and a non-ESKD population with staphylococcus (S.) aureus endocarditis.
Hemodialysis-treated ESKD patients with S. aureus endocarditis were identified from Danish National Registries and Non-ESKD patients from The East Danish Database on Endocarditis. For establishing the cause of death The Danish Registry of Cause of Death was used. Independent risk factors of outcome were identified in multivariable Cox regression models.
One hundred twenty-one hemodialysis patients and 190 non-ESKD patients with S. aureus endocarditis were included during 1996-2012 and 2002-2012, respectively. The all-cause in-hospital mortality was 22.3% in hemodialysis- and 24.7% in non-ESKD patients. One-year mortality, excluding in-hospital mortality, was 26.4% in hemodialysis patients and 15.2% in non-ESKD patients. The hazard ratio of all-cause mortality in hemodialysis was 2.64 (95% CI 1.70-4.10) at > 70 days after admission compared with non-ESKD. Age (HR 1.03 (95% CI 1.02-1.04)) and diabetes mellitus (HR 2.17 (95% CI 1.54-3.10)) were independent risk factors of all-cause mortality. The hazard ratio of cardiovascular death in hemodialysis was 3.20 (95% CI 1.78-5.77) at > 81 days after admission compared with non-ESKD. Age and diabetes mellitus were independently related to cardiovascular death.
All-cause in-hospital mortality rates were similar in hemodialysis and non-ESKD patients with S. aureus endocarditis whereas one-year mortality rates were significantly increased in the hemodialysis population.
与普通人群相比，接受慢性血液透析的患者感染性心内膜炎（IE）风险显著增加，但相关结局数据较少。本研究调查了接受血液透析治疗的终末期肾病（ESKD）和非ESKD金黄色葡萄球菌心内膜炎患者的死亡原因及危险因素。
从丹麦国家登记处识别接受血液透析治疗的金黄色葡萄球菌心内膜炎ESKD患者，从东丹麦心内膜炎数据库识别非ESKD患者。使用丹麦死亡原因登记处确定死亡原因。在多变量Cox回归模型中识别结局的独立危险因素。
1996年至2012年及2002年至2012年期间，分别纳入了121例接受血液透析的金黄色葡萄球菌心内膜炎患者和190例非ESKD患者。血液透析患者和非ESKD患者的全因住院死亡率分别为22.3%和24.7%。排除住院死亡率后，血液透析患者的1年死亡率为26.4%，非ESKD患者为15.2%。与非ESKD患者相比，血液透析患者入院>70天后全因死亡的风险比为2.64（95%CI 1.70-4.10）。年龄（HR 1.03（95%CI 1.02-1.04））和糖尿病（HR 2.17（95%CI 1.54-3.10））是全因死亡的独立危险因素。与非ESKD患者相比，血液透析患者入院>81天后心血管死亡的风险比为3.20（95%CI 1.78-5.77）。年龄和糖尿病与心血管死亡独立相关。
金黄色葡萄球菌心内膜炎的血液透析患者和非ESKD患者的全因住院死亡率相似，而血液透析人群的1年死亡率显著增加。
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