Maser Maarja, Freisinger Eva, Bronstein Leo, Köppe Jeanette, Orwat Stefan, Kaleschke Gerrit, Baumgartner Helmut, Diller Gerhard-Paul, Lammers Astrid
Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany.
Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany.
J Clin Med. 2021 Oct 29;10(21):5071. doi: 10.3390/jcm10215071.
Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The aim of this study was to analyse the frequency and outcome of IE in contemporary CHD patients based on all IE hospital admissions in Germany over a 10-year period.
Based on data of all hospital admissions in Germany from 2009 to 2018, we identified all CHD cases with a diagnosis of IE. The data contained information on patient demographics, diagnoses, surgical procedures, and mortality. The primary endpoint of the study was endocarditis-associated mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis, renal dialysis, resuscitation, or intubation).
Overall, 309,245 CHD inpatient cases were included in the analysis (underlying heart defects of simple complexity 55%, moderate complexity 23%, and complex heart defects 22%, respectively). Of those, 2512 (0.8% of all inpatient cases) were treated for IE. The mortality rate of IE inpatient cases was 6% with a major adverse events rate of 46%, and 41.5% of cases required surgical intervention. The overall IE associated mortality was lower in adult CHD cases compared to the 153,242 in adult IE cases without CHD (7.1% vs. 16.1%, < 0.001). After adjustments using multivariable logistic regression analysis, the presence or complexity of CHD was not associated with the outcomes. Meanwhile, age, male sex, and co-morbidities emerged as significant predictors of adverse outcomes.
IE accounts for a minority of CHD related hospitalizations but remains a deadly disease, and major adverse events are common in this setting. Due to different demographic and co-morbidity spectrums, adult CHD patients tend to have better survival prospects when compared to non-CHD IE patients. Acquired co-morbidities emerged as the main predictors of adverse outcomes.
感染性心内膜炎（IE）是先天性心脏病（CHD）患者的主要并发症，与高发病率和死亡率相关。本研究的目的是基于德国10年间所有IE住院病例，分析当代CHD患者中IE的发生率及预后情况。
基于2009年至2018年德国所有住院病例的数据，我们识别出所有诊断为IE的CHD病例。数据包含患者人口统计学信息、诊断、外科手术及死亡率。本研究的主要终点是心内膜炎相关死亡率以及主要不良事件（定义为死亡或心肌梗死、中风、肺栓塞、败血症、肾透析、复苏或插管）。
总体而言，309,245例CHD住院病例纳入分析（简单复杂性心脏缺陷占55%，中度复杂性占23%，复杂心脏缺陷占22%）。其中，2512例（占所有住院病例的0.8%）接受了IE治疗。IE住院病例的死亡率为6%，主要不良事件发生率为46%，41.5%的病例需要手术干预。与153,242例无CHD的成人IE病例相比，成人CHD病例的总体IE相关死亡率较低（7.1%对16.1%，P<0.001）。经多变量逻辑回归分析调整后，CHD的存在或复杂性与预后无关。同时，年龄、男性及合并症是不良预后的显著预测因素。
IE占CHD相关住院病例的少数，但仍是致命疾病，在此情况下主要不良事件很常见。由于人口统计学和合并症谱不同，与非CHD的IE患者相比，成人CHD患者往往有更好的生存前景。获得性合并症是不良预后的主要预测因素。
