Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria.
Division of Cardiac Thoracic Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, Austria.
Int J Mol Sci. 2023 Jul 21;24(14):11728. doi: 10.3390/ijms241411728.
(1) Infective endocarditis is a severe inflammatory disease associated with substantial mortality and morbidity. Alkaline phosphatase (AP) levels have been shown to change significantly during sepsis. Additionally, we previously found that a higher initial AP drop after cardiac surgery is associated with unfavorable outcomes. Therefore, the course of AP after surgery for endocarditis is of special interest. (2) A total of 314 patients with active isolated left-sided infective endocarditis at the Department of Cardiac Surgery (Medical University of Vienna, Vienna, Austria) between 2009 and 2018 were enrolled in this retrospective analysis. Blood samples were analyzed at different time points (baseline, postoperative days 1-7, postoperative days 14 and 30). Patients were categorized according to relative alkaline phosphatase drop (≥30% vs. <30%). (3) A higher rate of postoperative renal replacement therapy with or without prior renal replacement therapy (7.4 vs. 21.8%; = 0.001 and 6.7 vs. 15.6%; = 0.015, respectively) and extracorporeal membrane oxygenation (2.2 vs. 19.0%; = 0.000) was observed after a higher initial alkaline phosphatase drop. Short-term (30-day mortality 3.0 vs. 10.6%; = 0.010) and long-term mortality ( = 0.008) were significantly impaired after a higher initial alkaline phosphatase drop. (4) The higher initial alkaline phosphatase drop was accompanied by impaired short- and long-term outcomes after cardiac surgery for endocarditis. Future risk assessment scores for cardiac surgery should consider alkaline phosphatase.
(1) 感染性心内膜炎是一种严重的炎症性疾病，与较高的死亡率和发病率相关。碱性磷酸酶（AP）水平在脓毒症期间会发生显著变化。此外，我们之前发现心脏手术后初始 AP 下降幅度较大与不良结局相关。因此，心内膜炎手术后 AP 的变化过程具有特殊意义。(2) 本回顾性分析纳入了 2009 年至 2018 年在维也纳医科大学心脏外科（奥地利维也纳）接受治疗的 314 例活动性孤立性左侧感染性心内膜炎患者。在不同时间点（基线、术后第 1-7 天、术后第 14 天和第 30 天）分析血液样本。根据相对碱性磷酸酶下降幅度（≥30%与<30%）对患者进行分类。(3) 初始碱性磷酸酶下降幅度较大的患者术后需要接受肾脏替代治疗（RRT）或有 RRT 史的比例更高（7.4%比 21.8%；=0.001；6.7%比 15.6%；=0.015），需要体外膜肺氧合（ECMO）的比例也更高（2.2%比 19.0%；=0.000）。初始碱性磷酸酶下降幅度较大的患者短期（30 天死亡率 3.0%比 10.6%；=0.010）和长期死亡率（=0.008）均显著升高。(4) 心脏手术后初始碱性磷酸酶下降幅度较大与心内膜炎患者的短期和长期预后不良相关。未来的心脏手术风险评估评分应考虑碱性磷酸酶。
