感染性心内膜炎的临床表现、病因和结局。ESC-EORP EURO-ENDO（欧洲感染性心内膜炎）注册研究的结果：一项前瞻性队列研究。

Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study.

机构信息

Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille, France.

Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France.

出版信息

Eur Heart J. 2019 Oct 14;40(39):3222-3232. doi: 10.1093/eurheartj/ehz620.

DOI:10.1093/eurheartj/ehz620

PMID:31504413

Abstract

AIMS

The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE).

METHODS AND RESULTS

Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated.

CONCLUSION

Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

摘要

目的

EURO-ENDO 注册研究旨在探讨感染性心内膜炎（IE）患者的治疗管理和结局。

方法和结果

这是一项前瞻性队列研究，纳入了 2016 年 1 月至 2018 年 3 月期间，3116 名成年患者（欧洲 2470 例，非 ESC 国家 646 例），这些患者在 40 个国家的 156 家医院中，根据 ESC 2015 年诊断标准诊断为 IE。收集了临床、生物学、微生物学和影像学[超声心动图、计算机断层扫描（CT）、18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）]数据。IE 为原发性（NVE）1764 例（56.6%），人工瓣膜（PVIE）939 例（30.1%），器械相关（CDRIE）308 例（9.9%）。IE 为社区获得性感染 2046 例（65.66%）。涉及的微生物包括葡萄球菌 1085 例（44.1%）、口腔链球菌 304 例（12.3%）、肠球菌 390 例（15.8%）和牛链球菌 162 例（6.6%）。518 例患者（16.6%）进行了 18F-FDG PET/CT 检查，222 例（42.9%）患者有心脏摄取（主要标准），PVIE 的敏感性（66.8%）明显高于 NVE（28.0%）和 CDRIE（16.3%）。20.6%的患者发生栓塞事件，与三尖瓣或肺 IE、存在赘生物和金黄色葡萄球菌 IE 显著相关。根据 ESC 指南，2160 例（69.3%）患者需要心脏手术，但最终仅 1596 例（73.9%）患者接受了手术。532 例（17.1%）患者院内死亡，PVIE 患者死亡率更高。死亡率的独立预测因素包括 Charlson 指数、肌酐>2mg/dL、充血性心力衰竭、赘生物长度>10mm、脑并发症、脓肿和未及时手术。