Lin Yaowang, Dong Shaohong, Yuan Jie, Yu Danqing, Bei Weijie, Chen Ruimian, Qin Haiyan
Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Sciences, Guangzhou, China.
Front Med (Lausanne). 2021 Mar 25;8:576970. doi: 10.3389/fmed.2021.576970. eCollection 2021.
This study aimed to evaluate the accuracy and prognostic value of the sequential organ failure assessment (SOFA) score combined with C-reactive protein (CRP) in patients with complicated infective endocarditis (IE). A total of 246 consecutive patients with complicated IE were included in the multicentric prospective observational study. These patients were divided into four groups depending on the SOFA score and CRP optimal cutoff values (≥5 points and ≥17.6 mg/L, respectively), which were determined using the receiver operating characteristic analysis: low SOFA and low CRP ( = 83), low SOFA and high CRP ( = 87), high SOFA and low CRP ( = 25), and high SOFA and high CRP ( = 51). The primary endpoint was in-hospital death, and the secondary endpoint was long-time mortality, defined as subsequent readmission and 3-years mortality in the follow-up period. High SOFA score and high CRP were associated with approximately 29.410% (15/51) of higher incidence of in-hospital death with an area under the curve of 0.872. Multivariate analyses showed that age [odds ratio (OR) = 2.242, 1.142-4.401], neurological failure (Glasgow Coma Scale ≤ 12) (OR = 2.513, 1.041-4.224), (OR = 2.151, 1.252-4.513), SOFA ≥ 5 (OR = 9.320, 3.621-16.847), and surgical treatment (OR = 0.121, 0.031-0.342) were clinical predictors for in-hospital death. On following up for 12-36 months, SOFA ≥ 5 ( = 0.000) showed higher mortality. A high SOFA score combined with increased CRP levels is associated with in-hospital mortality. Also, SOFA score, but not CRP, predicts long-term mortality in complicated IE.
本研究旨在评估序贯器官衰竭评估（SOFA）评分联合C反应蛋白（CRP）对复杂性感染性心内膜炎（IE）患者的准确性及预后价值。多中心前瞻性观察性研究纳入了246例连续性复杂性IE患者。根据使用受试者工作特征分析确定的SOFA评分及CRP最佳截断值（分别为≥5分和≥17.6mg/L），将这些患者分为四组：低SOFA且低CRP组（n = 83）、低SOFA且高CRP组（n = 87）、高SOFA且低CRP组（n = 25）、高SOFA且高CRP组（n = 51）。主要终点为住院死亡，次要终点为长期死亡率，定义为随访期内再次入院及3年死亡率。高SOFA评分和高CRP与约29.410%（15/51）的较高住院死亡率相关，曲线下面积为0.872。多因素分析显示，年龄[比值比（OR）= 2.242，1.142 - 4.401]、神经功能衰竭（格拉斯哥昏迷量表≤12）（OR = 2.513，1.041 - 4.224）、[此处原文缺失部分内容]（OR = 2.151，1.252 - 4.513）、SOFA≥5（OR = 9.320，3.621 - 16.847）及手术治疗（OR = 0.121，0.031 - 0.342）是住院死亡的临床预测因素。随访12 - 36个月时，SOFA≥5（P = 0.000）显示死亡率更高。高SOFA评分联合CRP水平升高与住院死亡率相关。此外，SOFA评分而非CRP可预测复杂性IE的长期死亡率。
