心脏瓣膜手术后心内膜炎的医疗暴露及相关风险。

Healthcare exposures and associated risk of endocarditis after open-heart cardiac valve surgery.

机构信息

Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia.

Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.

出版信息

BMC Med. 2024 Feb 8;22(1):61. doi: 10.1186/s12916-024-03279-1.

DOI:10.1186/s12916-024-03279-1

PMID:38331876

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10854101/

Abstract

BACKGROUND

Infective endocarditis (IE) following cardiac valve surgery is associated with high morbidity and mortality. Data on the impact of iatrogenic healthcare exposures on this risk are sparse. This study aimed to investigate risk factors including healthcare exposures for post open-heart cardiac valve surgery endocarditis (PVE).

METHODS

In this population-linkage cohort study, 23,720 patients who had their first cardiac valve surgery between 2001 and 2017 were identified from an Australian state-wide hospital-admission database and followed-up to 31 December 2018. Risk factors for PVE were identified from multivariable Cox regression analysis and verified using a case-crossover design sensitivity analysis.

RESULTS

In 23,720 study participants (median age 73, 63% male), the cumulative incidence of PVE 15 years after cardiac valve surgery was 7.8% (95% CI 7.3-8.3%). Thirty-seven percent of PVE was healthcare-associated, which included red cell transfusions (16% of healthcare exposures) and coronary angiograms (7%). The risk of PVE was elevated for 90 days after red cell transfusion (HR = 3.4, 95% CI 2.1-5.4), coronary angiogram (HR = 4.0, 95% CI 2.3-7.0), and healthcare exposures in general (HR = 4.0, 95% CI 3.3-4.8) (all p < 0.001). Sensitivity analysis confirmed red cell transfusion (odds ratio [OR] = 3.9, 95% CI 1.8-8.1) and coronary angiogram (OR = 2.6, 95% CI 1.5-4.6) (both p < 0.001) were associated with PVE. Six-month mortality after PVE was 24% and was higher for healthcare-associated PVE than for non-healthcare-associated PVE (HR = 1.3, 95% CI 1.1-1.5, p = 0.002).

CONCLUSIONS

The risk of PVE is significantly higher for 90 days after healthcare exposures and associated with high mortality.

摘要

背景

心脏瓣膜手术后感染性心内膜炎（IE）与高发病率和死亡率相关。关于医源性医疗暴露对这种风险的影响的数据很少。本研究旨在调查包括医疗暴露在内的危险因素，以确定开胸心脏瓣膜手术后心内膜炎（PVE）的风险因素。

方法

在这项基于人群的队列研究中，从澳大利亚全州医院入院数据库中确定了 2001 年至 2017 年间接受首次心脏瓣膜手术的 23720 名患者，并随访至 2018 年 12 月 31 日。使用多变量 Cox 回归分析确定 PVE 的危险因素，并使用病例交叉设计敏感性分析进行验证。

结果

在 23720 名研究参与者（中位年龄 73 岁，63%为男性）中，心脏瓣膜手术后 15 年的 PVE 累积发生率为 7.8%（95%CI7.3-8.3%）。37%的 PVE 与医疗保健相关，其中包括红细胞输注（占医疗保健暴露的 16%）和冠状动脉造影术（占 7%）。红细胞输注后 90 天内 PVE 的风险增加（HR=3.4，95%CI2.1-5.4），冠状动脉造影术（HR=4.0，95%CI2.3-7.0），以及一般医疗保健暴露（HR=4.0，95%CI3.3-4.8）（均 p<0.001）。敏感性分析证实红细胞输注（比值比[OR]=3.9，95%CI1.8-8.1）和冠状动脉造影术（OR=2.6，95%CI1.5-4.6）（均 p<0.001）与 PVE 相关。PVE 后的 6 个月死亡率为 24%，且与非医疗保健相关 PVE 相比，医疗保健相关 PVE 的死亡率更高（HR=1.3，95%CI1.1-1.5，p=0.002）。