Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Can J Cardiol. 2019 Jun;35(6):721-726. doi: 10.1016/j.cjca.2019.02.006. Epub 2019 Feb 16.
Lesion complexity and prosthetic valves are known risk factors for infective endocarditis in patients with congenital heart disease. Tetralogy of Fallot (TOF) is the most common complex/cyanotic congenital heart disease and often requires prosthetic valve implantation. Population-based risk of endocarditis in TOF patients is unknown.
We reviewed the National Inpatient Sample (NIS) and identified admissions in TOF patients (>18 years), 2000 to 2014. The primary outcome was to describe incidence of endocarditis-related admissions. To assess trends, we divided the study period into tertiles: early (2000 to 2004), mid (2005 to 2009) and late (2010 to 2014) eras. The secondary outcome was to compare in-hospital mortality, complications, and health care resource utilization between admissions with and without endocarditis.
There were 393 (2.1%) endocarditis-related admissions among 18,353 admissions, and the incidence of endocarditis-related admissions increased over time: 1.9% (early era) vs 2.2% (mid-era) vs 2.4% (late era), P < 0.001. Overall in-hospital mortality was 6%. In addition to previously described risk factors for endocarditis, such as previous pacemaker/defibrillator or prosthetic valve implantation, we observed an association between endocarditis-related admissions and male gender, black race, and lower socioeconomic class. In comparison with admissions without endocarditis, the endocarditis-related admissions had higher in-hospital mortality, complications, and health care resource utilization measured by length of stay, inflation-adjusted hospitalization cost, and type of hospital discharge.
Incidence of endocarditis-related admissions increased over time and was associated with higher mortality, complications, and health care resource utilization. Further studies are required to investigate the observed temporal increase in incidence of endocarditis and explore new strategies to improve outcomes.
病变复杂性和人工瓣膜是已知的导致先天性心脏病患者感染性心内膜炎的风险因素。法洛四联症（TOF）是最常见的复杂/发绀型先天性心脏病，常需要植入人工瓣膜。TOF 患者的人群感染性心内膜炎风险尚不清楚。
我们回顾了国家住院患者样本（NIS），并确定了 2000 年至 2014 年 TOF 患者（>18 岁）的入院情况。主要结局是描述与心内膜炎相关的入院率。为了评估趋势，我们将研究期间分为三分位期：早期（2000 年至 2004 年）、中期（2005 年至 2009 年）和晚期（2010 年至 2014 年）。次要结局是比较有心内膜炎和无心内膜炎入院患者的住院死亡率、并发症和医疗资源利用情况。
在 18353 例入院患者中，有 393 例（2.1%）与心内膜炎相关的入院，并且心内膜炎相关入院的发生率随时间增加：1.9%（早期）、2.2%（中期）和 2.4%（晚期），P<0.001。总体住院死亡率为 6%。除了先前描述的心内膜炎风险因素，如先前的起搏器/除颤器或人工瓣膜植入，我们还观察到心内膜炎相关入院与男性、黑人种族和较低社会经济阶层之间存在关联。与无心内膜炎的入院相比，心内膜炎相关入院的住院死亡率、并发症和医疗资源利用（以住院时间、通货膨胀调整后的住院费用和出院类型衡量）更高。
心内膜炎相关入院的发生率随时间增加，与死亡率更高、并发症更多和医疗资源利用更多相关。需要进一步研究以探讨观察到的心内膜炎发病率的时间增加，并探索改善结局的新策略。
