Ly Reaksmei, Compain Fabrice, Gaye Bamba, Pontnau Florence, Bouchard Melissa, Mainardi Jean-Luc, Iserin Laurence, Lebeaux David, Ladouceur Magalie
Université de Paris, Hôpital Européen Georges Pompidou, France.
Adult Congenital Heart Disease Unit, Centre de Référence des Malformations Cardiaques Congénitales Complexes, France.
Eur Heart J Acute Cardiovasc Care. 2021 May 11;10(3):320–328. doi: 10.1177/2048872620901394. Epub 2020 Jan 28.
Infective endocarditis is a severe infection which can occur in adult patients with congenital heart disease. We aimed to determine outcomes and risk factors of death in adult congenital heart disease and to investigate differences with infective endocarditis in non-congenital heart disease.
Between March 2000 and June 2018, 671 consecutive episodes of infective endocarditis in adult patients were retrospectively recorded. Cases were classified according to the modified Duke classification. All adult congenital heart disease cases were managed by infectious disease specialists and adult congenital heart disease cardiologists. During this period, 142 infective endocarditis episodes (21%) occurred in adult congenital heart disease patients with simple (46.5%), moderate (21.1%), or complex (32.4%) congenital heart disease. In-hospital mortality was 12.7%. The strongest predictive factors of in-hospital death in multivariate analysis were complexity of congenital heart disease (odds ratio (OR) 8.02, 95% confidence interval (CI) 1.53-42.07), age (OR 1.05, 95% CI 1.00-1.19) and white blood cell count 12 g/L or greater (OR 8.72, 95% CI 2.42-31.43). Patients with congenital heart disease were significantly younger (median age 36 vs. 67 years, <0.001), had undergone more redo cardiac surgeries (35.7% vs. 11.3%, <0.01) and presented with more right-sided infective endocarditis (39.4% vs. 7.9%, <0.01) than patients without congenital heart disease. Congenital heart disease was associated with two-fold lower in-hospital mortality rates (OR 0.37, 95% CI 0.19-0.74), independently of age, gender, obesity, renal function and side of infective endocarditis.
Although mortality associated with infective endocarditis is lower in adult patients with congenital heart disease than patients without congenital heart disease, infective endocarditis mortality is particularly high in patients with complex congenital heart disease. Education and prevention about the risk of infective endocarditis is essential, especially in this group.
感染性心内膜炎是一种严重感染，可发生于患有先天性心脏病的成年患者。我们旨在确定成年先天性心脏病患者的死亡结局和危险因素，并调查其与非先天性心脏病患者感染性心内膜炎的差异。
回顾性记录了2000年3月至2018年6月期间成年患者连续发生的671例感染性心内膜炎发作情况。病例根据改良的杜克分类法进行分类。所有成年先天性心脏病病例均由传染病专家和成年先天性心脏病心脏病专家进行管理。在此期间，142例（21%）感染性心内膜炎发作发生在患有简单（46.5%）、中度（21.1%）或复杂（32.4%）先天性心脏病的成年先天性心脏病患者中。住院死亡率为12.7%。多因素分析中住院死亡的最强预测因素是先天性心脏病的复杂性（比值比（OR）8.02，95%置信区间（CI）1.53 - 42.07）、年龄（OR 1.05，95% CI 1.00 - 1.19）和白细胞计数12 g/L或更高（OR 8.72，95% CI 2.42 - 31.43）。与无先天性心脏病的患者相比，先天性心脏病患者明显更年轻（中位年龄36岁对67岁，<0.001），接受再次心脏手术的比例更高（35.7%对11.3%，<0.01），右侧感染性心内膜炎的发生率更高（39.4%对7.9%，<0.01）。先天性心脏病与住院死亡率降低两倍相关（OR 0.37，95% CI 0.19 - 0.74），与年龄、性别、肥胖、肾功能和感染性心内膜炎的部位无关。
尽管患有先天性心脏病的成年患者感染性心内膜炎相关死亡率低于无先天性心脏病的患者，但复杂先天性心脏病患者的感染性心内膜炎死亡率特别高。关于感染性心内膜炎风险的教育和预防至关重要，尤其是在这一群体中。
