Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Heart. 2021 Dec;107(23):1868-1874. doi: 10.1136/heartjnl-2020-318632. Epub 2021 Feb 25.
Current data suggest that a history of traumatic open skin wounds may be a risk factor for infectious endocarditis, with limited evidence. We tested the hypothesis that traumatic skin wound is a risk factor for infectious endocarditis.
Using the Japan Medical Data Center (JMDC) database (4 650 927 people aged 20-64 years, 2012-2018) and the Kumamoto database (493 414 people aged ≥65 years, 2012-2017), we conducted nested case-control and self-controlled case series (SCCS) analyses.
In the JMDC database, 544 cases hospitalised for infective endocarditis (IE) were matched with 2091 controls; 2.8% of cases and 0.5% of controls were exposed to traumatic skin wounds in the previous 1-4 weeks, with an adjusted OR of 4.31 (95% CI 1.74 to 10.7). In the Kumamoto database, 4.0% (27/670) of cases and 1.1% (29/2581) of controls were exposed to traumatic skin wounds in the previous 1-4 weeks, with an adjusted OR of 4.15 (95% CI 2.04 to 8.46). In the SCCS, the incidence rate ratios for IE were 2.61 (95% CI 1.67 to 4.09), 1.73 (95% CI 1.01 to 2.94), 1.19 (95% CI 0.63 to 2.27) and 1.52 (95% CI 0.82 to 2.74) for the Kumamoto database and 3.78 (95% CI 2.07 to 6.92), 1.58 (95% CI 0.64 to 3.89), 1.60 (95% CI 0.65 to 3.94) and 1.29 (95% CI 0.47 to 3.53) for the JMDC database at 1-4, 5-8, 9-12 and 13-16 weeks after traumatic skin wound, respectively, compared with the baseline period.
This study suggests that traumatic skin wound is a risk factor for IE 1-4 weeks after the wound.
目前的数据表明，创伤性开放性皮肤伤口史可能是感染性心内膜炎的一个危险因素，但证据有限。我们检验了创伤性皮肤伤口是感染性心内膜炎的危险因素这一假说。
我们使用日本医疗数据中心（JMDC）数据库（2012-2018 年，4650927 名 20-64 岁人群）和熊本数据库（2012-2017 年，493414 名≥65 岁人群），进行了嵌套病例对照和自身对照病例系列（SCCS）分析。
在 JMDC 数据库中，544 例因感染性心内膜炎（IE）住院的患者与 2091 例对照进行了匹配；2.8%的病例和 0.5%的对照在过去 1-4 周内有创伤性皮肤伤口暴露史，调整后的 OR 为 4.31（95%CI 1.74-10.7）。在熊本数据库中，4.0%（27/670）的病例和 1.1%（29/2581）的对照在过去 1-4 周内有创伤性皮肤伤口暴露史，调整后的 OR 为 4.15（95%CI 2.04-8.46）。在 SCCS 中，IE 的发病率比值在熊本数据库中分别为 2.61（95%CI 1.67-4.09）、1.73（95%CI 1.01-2.94）、1.19（95%CI 0.63-2.27）和 1.52（95%CI 0.82-2.74），在 JMDC 数据库中分别为 3.78（95%CI 2.07-6.92）、1.58（95%CI 0.64-3.89）、1.60（95%CI 0.65-3.94）和 1.29（95%CI 0.47-3.53），分别为创伤性皮肤伤口后 1-4、5-8、9-12 和 13-16 周与基线期相比。
本研究表明，创伤性皮肤伤口发生后 1-4 周是感染性心内膜炎的一个危险因素。
