Kazelian Lucía R, Gagliardi Juan A, Napoli Llobera Mariano E, Lespada María I, Beck Martín A, Cianciulli Tomás F
División Cardiología, Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina. E-mail:
División Cardiología, Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina.
Medicina (B Aires). 2021;81(6):939-945.
Infective endocarditis (IE) is a disease that in recent decades has shown changes in its presentation, diagnosis and treatment. This is a prospective study of 252 patients admitted at a reference hospital in Buenos Aires, Argentina, with a diagnosis of IE and they were grouped according to the decade of admission: Group A: from January 1988 to December 1997 (89 patients -35.3%-), Group B: from January 1998 to December 2007 (88 patients -34.9%-), and Group C: from January 2008 to December 2018 (75 patients -29.8%). The characteristics were analyzed and compared: age, sex, underlying heart disease, blood cultures and germs, presence of vegetations, surgical treatment and in-hospital mortality. Over the three decades, the predisposing heart condition showed that rheumatic valve disease decreased significantly (p < 0.0001) while the IE in cardiac devices also increased significantly (p < 0.0001). The percentage of blood culture-negatives decreased significantly over the years (p < 0.0001). In-hospital mortality showed a downward trend in the last decade (p = 0.069). The development of complications during hospitalization, the indication for surgery, and the presence of heart failure on admission were independent predictors of in-hospital mortality. The presence of vegetations and febrile syndrome on admission were independent predictor for lower mortality. The comparison over the years showed important changes in the epidemiological profile of IE. Probably due to advances in diagnostic techniques, treatment, and the implementation of interdisciplinary IE teams in the last decade, in-hospital mortality shows a strong tendency to decrease.
感染性心内膜炎（IE）是一种近几十年来在临床表现、诊断和治疗方面都发生了变化的疾病。这是一项对阿根廷布宜诺斯艾利斯一家参考医院收治的252例诊断为IE的患者进行的前瞻性研究，他们根据入院年代分组：A组：1988年1月至1997年12月（89例，占35.3%），B组：1998年1月至2007年12月（88例，占34.9%），C组：2008年1月至2018年12月（75例，占29.8%）。分析并比较了以下特征：年龄、性别、基础心脏病、血培养及病原菌、赘生物的存在情况、手术治疗及住院死亡率。在这三十年中，易患心脏病情况显示风湿性瓣膜病显著减少（p<0.0001），而心脏装置相关的IE也显著增加（p<0.0001）。多年来血培养阴性的百分比显著下降（p<0.0001）。住院死亡率在过去十年呈下降趋势（p = 0.069）。住院期间并发症的发生、手术指征以及入院时是否存在心力衰竭是住院死亡率的独立预测因素。入院时存在赘生物和发热综合征是较低死亡率的独立预测因素。多年来的比较显示IE的流行病学特征发生了重要变化。可能由于诊断技术的进步以及过去十年跨学科IE团队的建立，住院死亡率呈现出明显的下降趋势。
