Ucciferri Claudio, Auricchio Antonio, Cutone Carmine, Di Gasbarro Alessandro, Vecchiet Jacopo, Falasca Katia
Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti-Pescara, 66100 Chieti, Italy.
Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy.
Infect Dis Rep. 2022 Mar 21;14(2):213-219. doi: 10.3390/idr14020026.
Background: Nowadays, infective endocarditis (IE) is still burdened by a high mortality. In the absence of an adequate prognostic stratification system, it is important to assess new predictors of poor outcomes. The aim of our study is to evaluate which factors were associated with higher mortality in IE patients. Methods: A retrospective cohort study enrolled patients with an IE diagnosis at the Infectious Diseases Clinic of the University ‘G. D’Annunzio’, Chieti, Italy from January 2013 to December 2019. For each patient, demographic, anamnestic and clinical information, embolic phenomena, laboratory and microbiologic data, treatment, and outcomes were collected and analyzed. A correlation analysis was performed. Results: Sixty-eight patients with EI were studied; among them, the mortality was 17.6%, 20.6%, and 23.5%, intra-hospital, at 1 month from discharge and at 6 months from discharge, respectively. Mortality was significantly correlated with age, estimated glomerular filtration rate, and procalcitonin values when considering either basal values (r = 0.266, p = 0.029), or values at 48−72 h from the start of an antibiotic therapy (r = 0.222; p < 0.05), cerebral embolization for 6-month mortality (r = 0.284; p = 0.019), and inadequate antibiotic therapy (r = 0.232, p < 0.05). Conclusions: Procalcitonin values, at EI diagnosis and at 48−72 h after starting antibiotics, are prognostic factors useful for stratifying patient risk, and for setting up a personalized treatment. Of note, cerebral embolization and an inappropriate empirical treatment were associated with a higher mortality in the short- and long-term.
如今，感染性心内膜炎（IE）的死亡率仍然很高。在缺乏适当的预后分层系统的情况下，评估不良结局的新预测因素很重要。我们研究的目的是评估哪些因素与IE患者的较高死亡率相关。方法：一项回顾性队列研究纳入了2013年1月至2019年12月在意大利基耶蒂“G. D’Annunzio”大学传染病诊所诊断为IE的患者。收集并分析了每位患者的人口统计学、既往史和临床信息、栓塞现象、实验室和微生物学数据、治疗及结局。进行了相关性分析。结果：研究了68例EI患者；其中，院内死亡率、出院后1个月和出院后6个月的死亡率分别为17.6%、20.6%和23.5%。在考虑基础值（r = 0.266，p = 0.029）或抗生素治疗开始后48 - 72小时的值时，死亡率与年龄、估计肾小球滤过率和降钙素原值显著相关（r = 0.222；p < 0.05），6个月死亡率与脑栓塞相关（r = 0.284；p = 0.019），以及抗生素治疗不足相关（r = 0.232，p < 0.05）。结论：EI诊断时以及开始使用抗生素后48 - 72小时的降钙素原值是用于对患者风险进行分层以及制定个性化治疗的有用预后因素。值得注意的是，脑栓塞和不适当的经验性治疗在短期和长期均与较高死亡率相关。
