Urja Prakrity, Walters Ryan W, Vivekanandan Renuga, Kumar Mukund, Abdulghani Saadi, Hari Belbase Ram, Zook Nina, Mahesh Alla Venkata
Department of Cardiology, Creighton University School of Medicine, Omaha, Nebraska.
Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, Nebraska.
Echocardiography. 2019 Sep;36(9):1625-1632. doi: 10.1111/echo.14473. Epub 2019 Aug 31.
Infective endocarditis occurs in approximately 10%-30% of patients with Staphylococcus aureus bacteremia (SaB). Guidelines recommend echocardiography in patients with SaB and risk factors for infective endocarditis in the absence of any obvious source of infection. Herein, we explored the trends in the use of echocardiography in patients with SaB and its relationship to outcomes using a large national database.
All patients with a principal discharge diagnosis of SaB were identified using the National Inpatient Sample database from 2001 to 2014. Procedure code 88.72 was used to identify echocardiography. Logistic regression models were estimated to identify the year-over-year trends in echocardiogram, predictors of use, and association with mortality.
From 2001 to 2014, there were 668 423 hospitalizations with SaB diagnosis and 86 387 (12.9%) had echocardiogram. The rate of echocardiography increased from 10.7% in 2001 to 15.2% in 2014 (p < 0.001). Major predictors of echocardiogram usage were younger age, male gender, presence of sepsis, valvular or congenital heart disease, prosthetic heart valve (PHV), cardiac implantable electronic device (CIED), hemodialysis, and drug abuse. The adjusted rates of echocardiography increased from approximately 10% to 15% in hospitalizations without risk factors for IE while for high-risk groups like PHV and CIED it remained constant at 30% and 19%, respectively. Echocardiography was associated with 31% lower odds of in-hospital mortality.
The increase in echocardiography rate was largely attributable to increased use in those without risk factors while usage in those with PHV and CIED remained much lower than expected. Echocardiography use was associated with lower risk-adjusted mortality. These findings require further study and confirmation.
感染性心内膜炎发生于约10%-30%的金黄色葡萄球菌菌血症（SaB）患者中。指南建议，对于患有SaB且有感染性心内膜炎风险因素但无任何明显感染源的患者，应进行超声心动图检查。在此，我们使用一个大型国家数据库探讨了SaB患者超声心动图检查的使用趋势及其与预后的关系。
利用2001年至2014年的国家住院患者样本数据库确定所有主要出院诊断为SaB的患者。使用程序代码88.72来识别超声心动图检查。估计逻辑回归模型以确定超声心动图逐年的趋势、使用的预测因素以及与死亡率的关联。
2001年至2014年期间，有668423例住院患者被诊断为SaB，其中86387例（12.9%）进行了超声心动图检查。超声心动图检查的比例从2001年的10.7%增至2014年的15.2%（p<0.001）。超声心动图检查使用的主要预测因素包括年龄较小、男性、存在脓毒症、瓣膜或先天性心脏病、人工心脏瓣膜（PHV）、心脏植入式电子设备（CIED）、血液透析和药物滥用。在无感染性心内膜炎风险因素的住院患者中，超声心动图检查的校正比例从约10%增至15%，而对于PHV和CIED等高风险组，该比例分别保持在30%和19%不变。超声心动图检查与住院死亡率降低31%的几率相关。
超声心动图检查比例的增加主要归因于无风险因素患者使用量的增加，而PHV和CIED患者的使用量仍远低于预期。超声心动图检查的使用与风险调整后较低的死亡率相关。这些发现需要进一步研究和证实。
