中国一家三级医院240例感染性心内膜炎患者院内死亡的临床特征及危险因素：一项回顾性研究

Clinical Characteristics and Risk Factors for in-Hospital Mortality in 240 Cases of Infective Endocarditis in a Tertiary Hospital in China: A Retrospective Study.

作者信息

Zhang Xiaohui, Jin Fei, Lu Yanfei, Ni Fang, Xu Yuqiao, Xia Wenying

机构信息

Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.

Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China.

出版信息

Infect Drug Resist. 2022 Jun 18;15:3179-3189. doi: 10.2147/IDR.S362601. eCollection 2022.

DOI:10.2147/IDR.S362601

PMID:35754785

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9215907/

Abstract

PURPOSE

This study aimed (i) to investigate the clinical characteristics and risk factors related to in-hospital mortality in patients with infective endocarditis (IE) and (ii) to compare the differences in three age groups.

METHODS

A total of 240 IE cases diagnosed using the modified Duke criteria between January 2016 and December 2019 were included and retrospectively studied. Patients were stratified into three age groups: < 50 y, 50-65 y, and > 65 y.

RESULTS

The mean age of the patients was 51 ± 14 y, and 154 patients (64.2%) were male. In addition, 136 (56.7%) patients with IE had no previous cardiac disease. Congenital heart disease (CHD, 21.3%) was the most common underlying heart disease, followed by rheumatic heart disease (RHD, 8.8%). was found in 55 (22.9%) patients and was the most common causative pathogen, comprising 52.9% of all positive blood cultures. Echocardiography showed the presence of vegetations in 88.3% of cases and the predominant involvement of the left heart valves. Fever and cardiac murmur were the most frequent presentations, with no significant differences among age groups. Compared with younger patients, elderly patients had a lower operation rate and higher in-hospital mortality. The independent risk factors of in-hospital mortality were age > 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III-IV, and prosthetic valve infection.

CONCLUSION

CHD replaces RHD as the most common underlying heart disease in IE patients. Patients without previous cardiac disease are at increased risk of IE. is still the primary causative pathogen of IE. Elderly patients present with more comorbidities and complications, in addition to a more severe prognosis than younger patients. Age older than 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III-IV, and prosthetic valve infection showed poorer in-hospital outcomes.

摘要

目的

本研究旨在（i）调查感染性心内膜炎（IE）患者院内死亡的临床特征及危险因素，（ii）比较三个年龄组之间的差异。

方法

纳入2016年1月至2019年12月期间使用改良Duke标准诊断的240例IE病例，并进行回顾性研究。患者被分为三个年龄组：<50岁、50 - 65岁和>65岁。

结果

患者的平均年龄为51±14岁，154例（64.2%）为男性。此外，136例（56.7%）IE患者既往无心脏病。先天性心脏病（CHD，21.3%）是最常见的基础心脏病，其次是风湿性心脏病（RHD，8.8%）。55例（22.9%）患者中发现[此处原文缺失具体病原体名称]，是最常见的致病病原体，占所有阳性血培养的52.9%。超声心动图显示88.3%的病例存在赘生物，且主要累及左心瓣膜。发热和心脏杂音是最常见的表现，各年龄组之间无显著差异。与年轻患者相比，老年患者的手术率较低，院内死亡率较高。院内死亡的独立危险因素为年龄>65岁、颅内感染、脾栓塞、脑出血、纽约心脏协会（NYHA）心功能分级III - IV级和人工瓣膜感染。

结论

CHD取代RHD成为IE患者最常见的基础心脏病。既往无心脏病的患者患IE的风险增加。[此处原文缺失具体病原体名称]仍然是IE的主要致病病原体。老年患者除了比年轻患者预后更差外，还伴有更多的合并症和并发症。年龄大于65岁、颅内感染、脾栓塞、脑出血、NYHA心功能分级III - IV级和人工瓣膜感染的患者院内结局较差。