Infectious Diseases Service, Hospital Clínic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
Department of Genetics, Microbiology and Statistics, University de Barcelona, Barcelona, Spain.
J Am Coll Cardiol. 2021 Apr 6;77(13):1629-1640. doi: 10.1016/j.jacc.2021.02.014.
Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD).
This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients.
Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression.
A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non-HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p < 0.001). Cardiac surgery was less frequently performed among HD patients (30.6% vs. 46.2%; p < 0.001), whereas relapses were higher (9.4% vs. 2.7%; p < 0.001). Risk factors for 6-month mortality included Charlson score (hazard ratio [HR]: 1.26; 95% confidence interval [CI]: 1.11 to 1.44; p = 0.001), CNS emboli and other emboli (HR: 3.11; 95% CI: 1.84 to 5.27; p < 0.001; and HR: 1.73; 95% CI: 1.02 to 2.93; p = 0.04, respectively), persistent bacteremia (HR: 1.79; 95% CI: 1.11 to 2.88; p = 0.02), and acute onset heart failure (HR: 2.37; 95% CI: 1.49 to 3.78; p < 0.001).
HD-IE is a health care-associated infection chiefly caused by S. aureus, with increasing rates of enterococcal IE. Mortality and relapses are very high and significantly larger than in non-HD-IE patients, whereas cardiac surgery is less frequently performed.
感染性心内膜炎（IE）是接受慢性血液透析（HD）治疗的患者常见且严重的并发症。
本研究旨在探讨 HD 患者与非 HD 患者的 IE 并发症、心脏手术、复发和死亡率是否存在显著差异。
前瞻性队列研究（国际心内膜炎数据库合作研究，纳入 2000 年至 2006 年和 2008 年至 2012 年期间的 7715 例 IE 病例）。对基线特征、流行病学和病因学特征、并发症和结局进行描述性分析，并对 HD 和非 HD 患者进行比较。使用多变量逻辑回归分析 HD 患者主要栓塞事件、心脏手术、复发以及住院和 6 个月死亡率的危险因素。
共纳入 6691 例患者，其中 553 例（8.3%）接受 HD。北美地区 HD-IE 比例高于其他地区。主要病原体为金黄色葡萄球菌（47.8%），其次为肠球菌（15.4%）。HD 与非 HD-IE 患者的住院和 6 个月死亡率均显著升高（30.4% vs. 17%和 39.8% vs. 20.7%；均 p<0.001）。HD 患者心脏手术的比例较低（30.6% vs. 46.2%；p<0.001），但复发率较高（9.4% vs. 2.7%；p<0.001）。6 个月死亡率的危险因素包括 Charlson 评分（风险比 [HR]：1.26；95%置信区间 [CI]：1.11 至 1.44；p=0.001）、中枢神经系统栓塞和其他栓塞（HR：3.11；95% CI：1.84 至 5.27；p<0.001；和 HR：1.73；95% CI：1.02 至 2.93；p=0.04）、持续性菌血症（HR：1.79；95% CI：1.11 至 2.88；p=0.02）和急性心力衰竭（HR：2.37；95% CI：1.49 至 3.78；p<0.001）。
HD-IE 是一种与医疗保健相关的感染，主要由金黄色葡萄球菌引起，肠球菌性 IE 的发生率逐渐增加。死亡率和复发率非常高，明显高于非 HD-IE 患者，而心脏手术的比例较低。
