Early predictors of in-hospital death in infective endocarditis
Early predictors of in-hospital death in infective endocarditis
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DOI：
10.1161/01.cir.0000124719.61827.7f
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发表时间：
2004-04-13
期刊：
影响因子：
37.8
通讯作者：
Wang, A
中科院分区：
文献类型：
--
作者：
Chu, VH;Cabell, CH;Wang, A
感染性心内膜炎（IE）预后的早期决定因素的数据有限.我们评估了一个大的，前瞻性队列的患者IE.Methods和结果的早期临床特征的预后意义-二百六十七个连续的患者明确或可能的IE修改后的杜克标准和超声心动图进行了评估在7天内的介绍。急性生理学评估急性生理学，年龄，慢性健康评价II（APACHE II）评分时的表现，早期心力衰竭诊断的Fragrance标准。队列中的住院死亡率为19%，与明确或可能的IE患者相似（分别为20%和16%; P = 0.464）。Logistic回归模型确定的死亡的独立预测因子是糖尿病（OR 2.48; 95% CI，1.24 - 4.96），金黄色葡萄球菌为致病微生物（OR，2.06; 95% CI，1.01 - 4.20）、APACHE II评分（OR，1.07; 95% CI，1.01 - 1.12）和栓塞事件（OR，2.79; 95% CI，1.15 - 6.80）。早期超声心动图结果的杜克标准是没有预测death.Conclusions早期在IE的过程中，现成的临床特征，反映了宿主-病原体的相互作用是预测院内死亡。这些因素可能会识别那些IE患者进行更积极的治疗。
Background - Data on early determinants of outcome in infective endocarditis (IE) are limited. We evaluated the prognostic significance of early clinical characteristics in a large, prospective cohort of patients with IE.Methods and Results - Two hundred sixty-seven consecutive patients with definite or possible IE by modified Duke criteria and echocardiography performed within 7 days of presentation were evaluated. Acute physiology was assessed by the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score at the time of presentation, and early heart failure was diagnosed by Framingham criteria. In-hospital mortality rate in the cohort was 19% and similar for patients with definite or possible IE (20% versus 16%, respectively; P = 0.464). Independent predictors of death determined by logistic regression modeling were diabetes mellitus (OR 2.48; 95% CI, 1.24 to 4.96), Staphylococcus aureus as causative organism (OR, 2.06; 95% CI, 1.01 to 4.20), APACHE II score ( OR, 1.07; 95% CI, 1.01 to 1.12), and embolic event (OR, 2.79; 95% CI, 1.15 to 6.80). Early echocardiographic findings of the Duke criteria were not predictive of death.Conclusions - Early in the course of IE, readily available clinical characteristics that reflect the host-pathogen interaction are predictive of in-hospital death. These factors may identify those patients with IE for more aggressive treatment.