Ulas Esen, Duffels Mariëlle, Drexhage Olivier, Germans Tjeerd, Wagenaar Jiri, Umans Victor
Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands.
Department of Infectious Diseases, Northwest Clinics, Alkmaar, The Netherlands.
Neth Heart J. 2024 Dec;32(12):455-461. doi: 10.1007/s12471-024-01908-1. Epub 2024 Nov 5.
This study investigates the effects of spondylodiscitis on the inflammation burden in infective endocarditis patients.
A prospective, observational study was conducted between September 2018 and October 2022 in a non-surgical teaching hospital. Patients with a definite or possible and treated as infective endocarditis were recruited from the Alkmaar Endocarditis Team meetings. Spondylodiscitis was diagnosed based on symptoms and radiological findings. The inflammation burden was defined as the area under the C‑reactive protein (CRP) curve.
174 consecutive patients with infective endocarditis were included (mean age 73 years, 34.5% female). Concomitant spondylodiscitis was present in 32 patients (18%), frequently associated with Streptococcus species (38%). At admission, the mean level of CRP was significantly higher in patients with concomitant spondylodiscitis (p = 0.004). The median CRP area under the curve was significantly higher in spondylodiscitis patients (4.2 × 10 min.mg/l [1.2 × 10 - 1.6 × 10 min.mg/l] vs 2.0 × 10 min.mg/l [8.7 × 10 - 1.6 × 10 min.mg/l], p < 0.001). This difference remained during the whole treatment period. At 6 months of follow-up, rates of mortality and relapse of infective endocarditis were not significantly different.
The prevalence of spondylodiscitis in non-referred patients with infective endocarditis was 18%. Endocarditis patients with spondylodiscitis had an increased inflammation burden at and during admission. This difference in normalisation of CRP levels was particularly apparent in the final phase of antibiotic treatment but not related to infectious complications. Despite an augmented inflammation burden, spondylodiscitis was not associated with mortality, cardiac surgery or infectious relapse.
本研究调查了脊椎椎间盘炎对感染性心内膜炎患者炎症负担的影响。
2018年9月至2022年10月期间，在一家非外科教学医院进行了一项前瞻性观察研究。从阿尔克马尔心内膜炎团队会议中招募确诊或可能确诊并接受治疗的感染性心内膜炎患者。根据症状和影像学检查结果诊断脊椎椎间盘炎。炎症负担定义为C反应蛋白（CRP）曲线下面积。
纳入174例连续性感染性心内膜炎患者（平均年龄73岁，女性占34.5%）。32例患者（18%）合并脊椎椎间盘炎，常与链球菌属相关（38%）。入院时，合并脊椎椎间盘炎患者的CRP平均水平显著更高（p = 0.004）。脊椎椎间盘炎患者CRP曲线下面积中位数显著更高（4.2×10分钟·毫克/升[1.2×10 - 1.6×10分钟·毫克/升] vs 2.0×10分钟·毫克/升[8.7×10 - 1.6×10分钟·毫克/升]，p < 0.001）。在整个治疗期间，这种差异持续存在。随访6个月时，感染性心内膜炎的死亡率和复发率无显著差异。
未转诊的感染性心内膜炎患者中脊椎椎间盘炎的患病率为18%。合并脊椎椎间盘炎的心内膜炎患者在入院时及住院期间炎症负担增加。CRP水平恢复正常的这种差异在抗生素治疗的最后阶段尤为明显，但与感染并发症无关。尽管炎症负担增加，但脊椎椎间盘炎与死亡率、心脏手术或感染复发无关。
