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慢性血液透析患者的感染性心内膜炎:它仍是一个日益严峻的临床挑战吗?

Infective endocarditis in chronic hemodialysis patients is it still a growing clinical challenge?

作者信息

Spaleniak Sebastian, Lubas Arkadiusz, Kade Grzegorz, Smoszna Jerzy, Niemczyk Stanisław

机构信息

Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.

出版信息

Pol Merkur Lekarski. 2019 Feb 28;46(272):64-67.

Abstract

UNLABELLED

Patients requiring chronic dialysis are at increased risk for a severe complication such as Infective Endocarditis (IE). Infections, immediately after cardiovascular diseases, are the second leading cause of deaths in this group of patients. In the Polish population, the incidence of IE in hemodialysis patients is unknown.

AIM

The aim of the study was to present epidemiology, clinical and echocardiographic characteristics and microbiological profile of infective endocarditis with the evaluation of the suitability of the modified Duke criteria for the diagnosis of IE in hemodialysis patients.

MATERIALS AND METHODS

The aim of the study was to present epidemiology, clinical and echocardiographic characteristics and microbiological profile of infective endocarditis with the evaluation of the suitability of the modified Duke criteria for the diagnosis of IE in hemodialysis patients.

RESULTS

Ten cases of IE in HD patients were diagnosed. The incidence of IE was 1.55/10,000 dialysis sessions/year. The incidence rate for IE in the dialysis population was 2,000/100,000 patients/year, while the incidence rate for IE in all hospitalized individuals was 5/100,000 patients/year. Hemodialyzed patients had significantly higher odds of having IE compared to other hospitalized individuals (odds ratio [OR] = 69; 95%; CI: 35.92-132.06,p<0.0001). Mitral valve involvement was the most frequent. The most common IE etiology was Staphylococcus species. Based on the modified Duke criteria, the "definite IE" was recognized in one case whereas remaining 9 cases were classified as the "possible IE".

CONCLUSIONS

In hemodialyzed patients the risk of IE is approximately 69 times higher than in the general hospitalized population. Right heart valve involvement occurs seldom despite the presence of vascular catheters. The modified Duke criteria have a limited applicability in the diagnosis of infective endocarditis.

摘要

未标注

需要长期透析的患者发生诸如感染性心内膜炎(IE)等严重并发症的风险增加。感染是这类患者继心血管疾病之后的第二大死亡原因。在波兰人群中,血液透析患者IE的发病率尚不清楚。

目的

本研究的目的是介绍感染性心内膜炎的流行病学、临床和超声心动图特征以及微生物学概况,并评估改良的杜克标准对血液透析患者IE诊断的适用性。

材料与方法

本研究的目的是介绍感染性心内膜炎的流行病学、临床和超声心动图特征以及微生物学概况,并评估改良的杜克标准对血液透析患者IE诊断的适用性。

结果

确诊10例血液透析患者发生IE。IE的发病率为1.55/10000透析疗程/年。透析人群中IE的发病率为2000/100000患者/年,而所有住院患者中IE的发病率为5/100000患者/年。与其他住院患者相比,血液透析患者发生IE的几率显著更高(优势比[OR]=69;95%;置信区间:35.92 - 132.06,p<0.0001)。二尖瓣受累最为常见。最常见的IE病因是葡萄球菌属。根据改良的杜克标准,1例被诊断为“确诊IE”,其余9例被归类为“可能IE”。

结论

血液透析患者发生IE的风险比普通住院人群高约69倍。尽管存在血管导管,但右心瓣膜受累很少见。改良的杜克标准在感染性心内膜炎的诊断中适用性有限。

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