Infectious Diseases Service, Hospital Clinic-Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Centro Investigación Biomédica en Red Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Clin Infect Dis. 2021 Sep 7;73(5):765-774. doi: 10.1093/cid/ciab098.
Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking.
Prospectively collected cohort from 35 Spanish centers (2008-2018). Logistic regression analyses were performed to identify risk factors for developing CS and predictors of mortality.
Among 4856 endocarditis patients, 1652 (34%) had acute heart failure (AHF) and 244 (5%) CS. Compared with patients without AHF and AHF but no CS, patients with CS presented higher rates of surgery (40.5%, 52.5%, and 68%; P < .001) and in-hospital mortality (16.3%, 39.1%, and 52.5%). Compared with patients with septic shock, CS patients presented higher rates of surgery (42.5% vs 68%; P < .001) and lower rates of in-hospital and 1-year mortality (62.3% vs 52.5%, P = .008, and 65.3% vs 57.4%, P = .030). Severe aortic and mitral regurgitation (OR [95% CI], 2.47 [1.82-3.35] and 3.03 [2.26-4.07]; both P < .001), left-ventricle ejection fraction <60% (1.72; 1.22-2.40; P = .002), heart block (2.22; 1.41-3.47; P = .001), tachyarrhythmias (5.07; 3.13-8.19; P < .001), and acute kidney failure (2.29; 1.73-3.03; P < .001) were associated with higher likelihood of developing CS. Prosthetic endocarditis (2.03; 1.06 -3.88; P = .032), Staphylococcus aureus (3.10; 1.16 -8.30; P = .024), tachyarrhythmias (3.09; 1.50-10.13; P = .005), and not performing cardiac surgery (11.40; 4.83-26.90; P < .001) were associated with a higher risk of mortality.
AHF is common among patients with endocarditis. CS is associated with high mortality and should be promptly identified and assessed for cardiac surgery.
缺乏研究心源性休克 (CS) 对心内膜炎影响的研究。
这是一项来自 35 个西班牙中心的前瞻性收集队列研究（2008-2018 年）。采用 logistic 回归分析确定发生 CS 的风险因素和死亡率的预测因素。
在 4856 例心内膜炎患者中，1652 例（34%）出现急性心力衰竭（AHF），244 例（5%）发生 CS。与无 AHF 和 AHF 但无 CS 的患者相比，CS 患者手术率（40.5%、52.5%和 68%；P<0.001）和住院死亡率（16.3%、39.1%和 52.5%）更高。与感染性休克患者相比，CS 患者手术率更高（42.5% vs 68%；P<0.001），住院死亡率和 1 年死亡率更低（62.3% vs 52.5%，P=0.008，65.3% vs 57.4%，P=0.030）。严重主动脉瓣和二尖瓣反流（OR [95%CI]，2.47 [1.82-3.35] 和 3.03 [2.26-4.07]；均 P<0.001）、左心室射血分数<60%（1.72；1.22-2.40；P=0.002）、心脏传导阻滞（2.22；1.41-3.47；P=0.001）、心动过速（5.07；3.13-8.19；P<0.001）和急性肾损伤（2.29；1.73-3.03；P<0.001）与 CS 发生的可能性更高相关。人工心脏瓣膜心内膜炎（2.03；1.06-3.88；P=0.032）、金黄色葡萄球菌（3.10；1.16-8.30；P=0.024）、心动过速（3.09；1.50-10.13；P=0.005）和未行心脏手术（11.40；4.83-26.90；P<0.001）与死亡率升高相关。
AHF 在患有心内膜炎的患者中很常见。CS 与高死亡率相关，应及时识别并评估心脏手术的可能性。
