Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Eur Heart J Acute Cardiovasc Care. 2021 May 11;10(3):356-366. doi: 10.1093/ehjacc/zuab008.
Infective endocarditis (IE) is associated with high mortality and morbidity. Cardiac troponin (Tn) elevation seems to be common in patients with IE and could be associated with a poor prognosis. The aim of this study was to synthesize the prognostic value of Tn in patients with IE.
We searched in MEDLINE, EMBASE, and the Cochrane library, including the Cochrane Central Register of Controlled Trials (CENTRAL) until February 2020. Observational studies reporting on the association between Tn and in-hospital and 1-year mortality, and IE complications were considered eligible. As each centre uses different conventional or ultra-sensitive Tn, with different normality threshold, we considered them as normal or elevated according to the criteria specified in each article. Articles were systematically selected, assessed for bias, and, when possible, meta-analysed using a random effect model. After retrieving 542 articles, 18 were included for qualitative synthesis and 9 for quantitative meta-analysis. Compared with patients with normal Tn levels, patients with Tn elevation presented higher in-hospital mortality [odds ratio (OR) 5.96, 95% confidence interval (CI) 3.46-10.26; P < 0.0001], 1-year mortality (OR 2.67, 95% CI 1.42-5.02; P = 0.002), and surgery rates (OR 2.34, 95% CI 1.42-3.85; P = 0.0008). They also suffered more frequent complications: central nervous system events (OR 8.85, 95% CI 3.23-24.26; P < 0.0001) and cardiac abscesses (OR 4.96, 95% CI 1.94-12.70; P = 0.0008).
Tn elevation is associated with a poor prognosis in patients with IE. Troponin determination seems to provide additional help in the prognostic assessment of these patients.
感染性心内膜炎（IE）与高死亡率和高发病率相关。心肌肌钙蛋白（Tn）升高似乎在 IE 患者中很常见，并且可能与预后不良相关。本研究的目的是综合 Tn 在 IE 患者中的预后价值。
我们在 MEDLINE、EMBASE 和 Cochrane 图书馆进行了检索，包括 Cochrane 对照试验中心注册库（CENTRAL），检索截至 2020 年 2 月。纳入报告 Tn 与住院期间和 1 年死亡率以及 IE 并发症之间相关性的观察性研究。由于每个中心使用不同的常规或超敏 Tn，并且正常阈值不同，因此我们根据每篇文章中规定的标准将其视为正常或升高。对文章进行系统选择、偏倚评估，并在可能的情况下使用随机效应模型进行定量荟萃分析。在检索到 542 篇文章后，纳入 18 篇进行定性综合分析，纳入 9 篇进行定量荟萃分析。与 Tn 水平正常的患者相比，Tn 升高的患者住院期间死亡率更高[比值比（OR）5.96，95%置信区间（CI）3.46-10.26；P<0.0001]，1 年死亡率（OR 2.67，95%CI 1.42-5.02；P=0.002）和手术率（OR 2.34，95%CI 1.42-3.85；P=0.0008）。他们也更频繁地出现并发症：中枢神经系统事件（OR 8.85，95%CI 3.23-24.26；P<0.0001）和心脏脓肿（OR 4.96，95%CI 1.94-12.70；P=0.0008）。
Tn 升高与 IE 患者的不良预后相关。Tn 测定似乎为这些患者的预后评估提供了额外的帮助。
