严重心力衰竭患者口腔健康与感染相关参数之间潜在关联的二次分析-德国队列研究结果。

Secondary analysis of potential associations between oral health and infection-related parameters in patients with severe heart failure-results of a German cohort.

机构信息

Department of Cariology, Endodontology and Periodontology, University Leipzig, Liebigstr. 12, D 04103, Leipzig, Germany.

CRO Dr. med. Kottmann GmbH & Co. KG, Hamm, Germany.

出版信息

BMC Cardiovasc Disord. 2023 Nov 21;23(1):573. doi: 10.1186/s12872-023-03612-1.

DOI:10.1186/s12872-023-03612-1

PMID:37990175

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10664670/

Abstract

OBJECTIVES

Aim of this retrospective cohort study was to evaluate whether oral health parameters would be associated with infection-related parameters and overall survival of patients with severe heart failure (HF).

METHODS

Patients with severe HF, heart transplantation (HTx) and left-ventricular assist device (LVAD), which underwent a full oral examination between 2017 and 2018 were included. Infection-related and survival data were assessed from the patient´s medical records. The oral examination included: remaining teeth, caries and periodontal condition, including periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and diagnosis (staging/grading). In addition, the periodontal inflamed surface area (PISA) was determined. Statistical analysis included Chi-square, Fisher´s exact and Mann-Whitney-U test, as well as a logistic regression, considering age, gender, body-mass-index (BMI), diabetes and several oral health parameters with regard to overall survival and infections at heart/driveline.

RESULTS

329 patients (HTx: 34%, LVAD: 38.9%, HF: 27.1%), were included. Patients had on average 18.96 ± 8.90 remaining teeth, whereby the majority had a periodontitis stage III or IV (88.7%) and a grade B (80.5%). Higher BOP was associated with infections at heart/driveline (p = 0.04) and outside the heart (p < 0.01) during follow-up. Increased PISA was significantly associated with bacterial infections outside the heart (p < 0.01) and sepsis (p = 0.02). Only BMI of 25 or higher correlated with an increased risk of infections at heart/driveline in regression analysis (OR 3.063, CI 1.158-8.101, p = 0.02), while no associations between oral health parameters and infections at heart/driveline or overall survival were confirmed.

CONCLUSIONS

In patients with severe HF, periodontal inflammation might be associated with infection-related parameters. Improved dental care, especially including periodontal therapy and maintenance might be favourable to support prevention of infections in patients with severe HF.

摘要

目的

本回顾性队列研究旨在评估口腔健康参数是否与严重心力衰竭（HF）患者的感染相关参数和总体生存率相关。

方法

纳入 2017 年至 2018 年间接受全面口腔检查的严重 HF、心脏移植（HTx）和左心室辅助装置（LVAD）患者。从患者病历中评估感染相关和生存数据。口腔检查包括：剩余牙齿、龋齿和牙周状况，包括牙周探诊深度（PPD）、临床附着丧失（CAL）、探诊出血（BOP）和诊断（分期/分级）。此外，还确定了牙周炎炎症表面面积（PISA）。统计分析包括卡方检验、Fisher 确切检验和曼-惠特尼 U 检验，以及逻辑回归，考虑年龄、性别、体重指数（BMI）、糖尿病和几个口腔健康参数与整体生存率和心脏/驱动线感染的关系。

结果

共纳入 329 例患者（HTx：34%，LVAD：38.9%，HF：27.1%）。患者平均剩余牙齿 18.96±8.90 颗，其中多数患者患有牙周炎 III 期或 IV 期（88.7%）和 B 级（80.5%）。较高的 BOP 与随访期间心脏/驱动线感染（p=0.04）和心脏外感染（p<0.01）相关。PISA 增加与心脏外细菌感染（p<0.01）和败血症（p=0.02）显著相关。仅 BMI 为 25 或更高与回归分析中心脏/驱动线感染风险增加相关（OR 3.063，CI 1.158-8.101，p=0.02），而口腔健康参数与心脏/驱动线感染或整体生存率之间无关联。