感染性心内膜炎与实体器官移植：初始移植住院期间结局更差。
Infective endocarditis and solid organ transplantation: Only worse outcomes during initial transplantation hospitalization.
机构信息
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina.
Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, North Carolina.
出版信息
Am Heart J. 2021 Oct;240:63-72. doi: 10.1016/j.ahj.2021.06.007. Epub 2021 Jun 20.
BACKGROUND
The epidemiology, and outcome of infective endocarditis (IE) among solid organ transplant (SOT) recipients is unknown.
METHODS
We used data from the 2013-2018 Nationwide Readmissions Database (NRD). IE- and SOT-associated hospitalizations were identified using diagnosis and procedure codes. Outcomes included inpatient mortality, length of stay, and inpatient costs. Adjusted analyses were performed using weighted regression models.
RESULTS
A total of 99,052 IE-associated hospitalizations, corresponding to a weighted national estimate of 193,164, were included for analysis. Of these, 794 (weighted n = 1,574) were associated with transplant history (SOT-IE). Mortality was not significantly different between SOT-IE and non-SOT-IE (17.2% vs. 15.8%, adjusted relative risk [aRR]: 0.86, 95% confidence interval [CI] [0.71, 1.03]), and fewer SOT-IE patients underwent valve repair or replacement than non-SOT-IE (12.5% vs. 16.2%, aRR 0.82, 95% CI [0.71, 0.95]). We then compared outcomes of patients diagnosed with IE during their index transplant hospitalization (index-SOT-IE) to patients without IE during their transplant hospitalization (index-SOT). Index-SOT-IE occurred most frequently among heart transplant recipients (45.1%), and was associated with greater mortality (27.1% vs. 2.3%, aRR 6.07, 95% CI [3.32, 11.11]).
CONCLUSION
Dual diagnosis of SOT and IE was associated with worse outcomes among SOT recipients during index hospitalization, but not overall among patients with IE.
背景
实体器官移植（SOT）受者感染性心内膜炎（IE）的流行病学和结局尚不清楚。
方法
我们使用了 2013 年至 2018 年全国再入院数据库（NRD）的数据。使用诊断和程序代码识别 IE 和 SOT 相关的住院治疗。结果包括住院死亡率、住院时间和住院费用。使用加权回归模型进行调整分析。
结果
共纳入 99052 例 IE 相关住院治疗，加权全国估计为 193164 例。其中，794 例（加权 n=1574 例）与移植史（SOT-IE）相关。SOT-IE 和非 SOT-IE 之间的死亡率无显著差异（17.2%比 15.8%，调整后的相对风险[aRR]：0.86，95%置信区间[CI] [0.71，1.03]），且 SOT-IE 患者行瓣膜修复或置换术的比例低于非 SOT-IE 患者（12.5%比 16.2%，aRR 0.82，95% CI [0.71，0.95]）。然后，我们比较了在索引移植住院期间诊断为 IE 的患者（索引 SOT-IE）与在移植住院期间无 IE 的患者（索引 SOT）的结局。索引 SOT-IE 最常发生在心脏移植受者中（45.1%），与死亡率较高相关（27.1%比 2.3%，aRR 6.07，95% CI [3.32，11.11]）。
结论
在索引住院期间，SOT 和 IE 的双重诊断与 SOT 受者的结局较差相关，但在所有 IE 患者中并非如此。
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