Complicated infective endocarditis necessitating ICU admission: clinical course and prognosis
Complicated infective endocarditis necessitating ICU admission: clinical course and prognosis
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DOI：
10.1186/cc1474
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发表时间：
2002-04-01
期刊：
影响因子：
15.1
通讯作者：
Siostrzonek, P
中科院分区：
文献类型：
--
作者：
Delle Karth, G;Koreny, M;Siostrzonek, P
目的：探讨重症监护病房（icu）感染性心内膜炎复杂病程的发生率、临床病程及预后因素。方法：对1994 ~ 1999年在1所三级医院和1所大学医院的4个icu收治的4106例患者进行回顾性多中心观察性研究。结果：感染性心内膜炎33例（0.8%）。其中男性26例，平均年龄59 +/- 12岁，APACH E-III评分75 +/- 31分。转至ICU的原因为充血性心力衰竭占64%，感染性休克占21%，神经系统恶化占15%，心肺复苏占9%。73%的患者需要使用肌力药物或血管收缩剂，64%的患者出现多器官功能衰竭。21%的患者存在人工瓣膜心内膜炎。在96%的阳性培养物中发现革兰氏阳性球菌；27%的患者培养呈阴性。经胸超声心动图诊断率仅为33%，经食管超声心动图检查需要91%才能确诊或完全描述疾病范围。60%的患者接受手术治疗，其余40%仅接受药物治疗。两组入院时APACHE-III评分无统计学差异（69 30比84 +/- 34，P= 0.17）。内科治疗的住院死亡率为84%，手术治疗的住院死亡率为35%。通过多因素分析，入院时急性肾功能衰竭被确定为住院患者死亡的独立单一预测因素（OR 5, 95% Cl 1.04-24.03， P= 0.04）。结论：感染性心内膜炎需住院的患者预后严重。然而，数据表明，尽管存在严重休克和多器官功能衰竭，手术干预仍可在相当数量的患者中成功进行。
Aim: To study incidence, clinical course and prognostic factors in patients admitted to medical intensive care units (ICUs) because of a complicated course of infective endocarditis.Method: This was a retrospective multicenter observational study of 4106 patients admitted to four medical ICUs in one tertiary hospital and one university hospital between 1994 and 1999.Results: Infective endocarditis was identified in 33 (0.8%) patients. Of these, 26 were male, mean age was 59 +/- 12 and APACH E-III score was 75 +/- 31. Reasons for transfer to the ICU were congestive heart failure in 64%, septic shock in 21%, neurological deterioration in 15% and cardiopulmonary resuscitation in 9%. Inotropes or vasoconstrictors were required in 73% and multiorgan failure developed in 64% of the patients. Prosthetic valve endocarditis was present in 21%. Gram-positive cocci were found in 96% of all positive cultures; cultures were negative in 27% of the patients. Transthoracic echocardiograms were diagnostic in only 33% and transesophageal studies were required in 91% to confirm diagnosis or fully to delineate the extent of disease. Surgical intervention was performed in 60% of the patients, and the remaining 40% were only treated medically. The APACHE-III score on admission did not differ statistically between the two groups (69 30 versus 84 +/- 34, P= 0.17). In-patient mortality was 84% in patients treated medically, and 35% in surgically treated patients. Using multivariate analysis, acute renal failure on admission was identified as the independent single predictor for in-patient death (OR 5, 95% Cl 1.04-24.03, P= 0.04).Conclusion: The prognosis for patients with infective endocarditis requiring admission to a medical ICU is serious. Nevertheless, the data suggest that surgical intervention may be successfully performed in a substantial number of patients despite the presence of severe shock and occurrence of multiorgan failure.