美国人工瓣膜感染性心内膜炎的当代趋势和结局：来自全国住院患者样本的见解。

Contemporary Trends and Outcomes of Prosthetic Valve Infective Endocarditis in the United States: Insights from the Nationwide Inpatient Sample.

机构信息

Department of Medicine, West Virginia University, Morgantown, West Virginia.

Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia; Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California.

出版信息

Am J Med Sci. 2021 Nov;362(5):472-479. doi: 10.1016/j.amjms.2021.05.014. Epub 2021 May 24.

DOI:10.1016/j.amjms.2021.05.014

PMID:34033810

Abstract

BACKGROUND

Prosthetic valve endocarditis (PVE) carries high mortality and morbidity as compared to native valve endocarditis (NVE). Contemporary data on PVE are lacking, we aimed to study contemporary trends, outcomes, and burden of PVE using nationally representative data.

METHODS

We used the National Inpatient Sample from 2000 to 2017 to identify patients admitted with PVE using ICD-9-CM and ICD-10 codes. Risk-adjusted rates were calculated using an Analysis of Covariance (ANCOVA) with the Generalized Linear Model (GLM). Trends were assessed with linear regression and Pearson's Chi-square when appropriate. Binomial logistic regression was used to assess predictors of in-hospital mortality.

RESULTS

We identified 43,602 hospitalizations for PVE. PVE hospitalizations increased from 1803 in 2000 to 3450 in 2017. Risk-adjusted mortality decreased from 10.7% in 2002 to 7.3% in 2017 (P<0.01). Logistic regression analysis on mortality showed increase association with age (OR, 1.021, 95%CI [1.017-1.024], p<0.01), Hispanics (OR, 1.493, 95%CI [1.296-1.719], p<0.01) and patients with drug abuse (OR, 1.233, 95%CI [1.05-1.449], p=0.01). Co-morbid conditions like congestive heart failure (OR, 1.511, 95%CI [1.366-1.673], p<0.01), renal failure (OR, 1.572, 95%CI [1.427-1.732], p<0.01) and weight loss (OR, 1.425, 95%CI [1.093-1.419], p<0.01) were also associated with higher mortality.

CONCLUSIONS

Over the years the adjusted in-hospital mortality in PVE has trended down but the average cost of stay has increased despite decrease in length of stay.

摘要

背景

与原发性心内膜炎（NVE）相比，人工瓣膜心内膜炎（PVE）的死亡率和发病率更高。目前缺乏关于 PVE 的最新数据，本研究旨在利用全国代表性数据研究 PVE 的最新趋势、结局和负担。

方法

我们使用 2000 年至 2017 年的全国住院患者样本，使用国际疾病分类第 9 版-临床修正（ICD-9-CM）和国际疾病分类第 10 版（ICD-10）代码确定 PVE 患者。使用方差分析（ANCOVA）和广义线性模型（GLM）计算风险调整后发病率。采用线性回归和皮尔逊卡方检验评估趋势。采用二项逻辑回归评估住院死亡率的预测因素。

结果

共纳入 43602 例 PVE 住院患者。2000 年 PVE 住院患者为 1803 例，2017 年增加至 3450 例。风险调整后死亡率从 2002 年的 10.7%下降至 2017 年的 7.3%（P<0.01）。对死亡率的逻辑回归分析显示，年龄（OR，1.021，95%CI [1.017-1.024]，p<0.01）、西班牙裔（OR，1.493，95%CI [1.296-1.719]，p<0.01）和药物滥用患者（OR，1.233，95%CI [1.05-1.449]，p=0.01）与死亡率呈正相关。充血性心力衰竭（OR，1.511，95%CI [1.366-1.673]，p<0.01）、肾衰竭（OR，1.572，95%CI [1.427-1.732]，p<0.01）和体重减轻（OR，1.425，95%CI [1.093-1.419]，p<0.01）等合并症也与死亡率升高相关。