Firiana Lira, Siswanto Bambang Budi, Yonas Emir, Prakoso Radityo, Pranata Raymond
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta.
Faculty of Medicine, Universitas Yarsi, Jakarta, Indonesia.
Int J Angiol. 2020 Mar;29(1):12-18. doi: 10.1055/s-0039-3402744. Epub 2020 Feb 4.
Infective endocarditis retains high morbidity and mortality rates despite recent advances in diagnostics, pharmacotherapy, and surgical intervention. Risk stratification in endocarditis patients, including blood-culture negative endocarditis, is crucial in deciding the optimal management strategy; however, the studies investigating risk stratification in these patients were lacking despite the difference with blood-culture positive endocarditis. The aim of this study is to identify risk factors associated with in-hospital mortality in blood-culture negative infective endocarditis patients. A retrospective cohort study was conducted at National Cardiovascular Center Harapan Kita, Jakarta in blood-culture negative infective endocarditis patients from 2013 to 2015. Patient characteristics, clinical parameters, echocardiographic parameters, and clinical complications were collected from medical records and hospital information systems. There were 146 patients that satisfy the inclusion and exclusion criteria out of 162 patients with blood-culture infective endocarditis. The in-hospital mortality rate was 13.5%. On bivariate analyses, factors that were related to in-hospital mortality include New York Heart Association (NYHA) class III and IV heart failure ( = 0.007), history of hypertension ( = 0.021), stroke during hospitalization ( < 0.001), the decline in renal function ( < 0.001), and surgery ( = 0.028). Variables that were independently associated with mortality upon multivariate analysis were heart failure NYHA functional class III and IV (OR 7.56, = 0.011), worsening kidney function (OR 10.23, < 0.001), and stroke during hospitalization (OR 8.92, = 0.001). Presence of heart failure with NYHA functional class III and IV, worsening kidney function, and stroke during hospitalization were independently associated with in-hospital mortality in blood-culture infective endocarditis patients.
尽管在诊断、药物治疗和手术干预方面取得了最新进展，但感染性心内膜炎的发病率和死亡率仍然很高。对心内膜炎患者进行风险分层，包括血培养阴性的心内膜炎，对于确定最佳治疗策略至关重要；然而，尽管血培养阴性的心内膜炎与血培养阳性的心内膜炎有所不同，但针对这些患者进行风险分层的研究却很缺乏。本研究的目的是确定血培养阴性感染性心内膜炎患者住院死亡率的相关危险因素。2013年至2015年，在雅加达哈帕恩基塔国家心血管中心对血培养阴性感染性心内膜炎患者进行了一项回顾性队列研究。从病历和医院信息系统中收集患者特征、临床参数、超声心动图参数和临床并发症。在162例血培养感染性心内膜炎患者中，有146例符合纳入和排除标准。住院死亡率为13.5%。在二元分析中，与住院死亡率相关的因素包括纽约心脏协会（NYHA）III级和IV级心力衰竭（P = 0.007）、高血压病史（P = 0.021）、住院期间中风（P < 0.001）、肾功能下降（P < 0.001）和手术（P = 0.028）。多变量分析中与死亡率独立相关的变量是NYHA功能分级III级和IV级心力衰竭（OR 7.56，P = 0.011）、肾功能恶化（OR 10.23，P < 0.001）和住院期间中风（OR 8.92，P = 0.001）。NYHA功能分级III级和IV级心力衰竭、肾功能恶化以及住院期间中风的存在与血培养感染性心内膜炎患者的住院死亡率独立相关。
