Infective endocarditis in a tertiary referral hospital: long-term follow up.
Infective endocarditis in a tertiary referral hospital: long-term follow up.
复制标题
三级转诊医院感染性心内膜炎：长期随访。
DOI：
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发表时间：
2012
影响因子：
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通讯作者：
M. Witsenburg
中科院分区：
文献类型：
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作者：
M. Mokhles;Isabella Ciampichetti;R. V. van Domburg;J. Cheng;A. Bogers;M. Witsenburg
研究背景和目的
感染性心内膜炎（IE）与显着的死亡率和发病率相关。本研究的目的是评估IE患者的长期生存率，并通过将其生存率与一般人群的年龄和性别匹配样本进行比较，客观地评估这些患者的死亡率。
方法
一项对1998年1月至2007年12月间入住三级转诊中心的IE成人（根据改良杜克标准确定）进行的回顾性观察性队列研究。使用Kaplan-Meier方法分析累积生存期。使用对数秩检验比较不同组，并进行多变量考克斯比例风险回归分析，以确定长期全因死亡率的预测因子。
结果
共评价了191例连续IE患者（176例左侧，15例右侧）。72%的病例进行了心脏手术，中位随访时间为6.3年。随访10年，累积长期生存率为59%，主要死亡原因为充血性心力衰竭（28%）和不同类型的恶性肿瘤（17%）。一般人群在随访1年、5年和10年后的年龄和性别匹配生存率分别为98%、92%和80%。长期死亡率的主要预测因素是癌症，而手术对长期生存有积极影响。
结论
尽管诊断和治疗进展，IE与高的长期死亡率相关。与一般荷兰人群相比，IE患者的生存率明显较低。即使在IE被治愈的情况下，与一般人群相比，这些患者的生存率也可能降低。因此，需要对这些患者进行仔细的随访。
BACKGROUND AND AIM OF THE STUDY
Infective endocarditis (IE) is associated with significant mortality and morbidity. The aim of the present study was to assess the long-term survival of patients with IE, and to assess objectively the mortality in these patients by comparing their survival with that of an age- and gender-matched sample of the general population.
METHODS
A retrospective observational cohort study of adults with IE, as determined by the modified Duke criteria, was admitted to a tertiary referral center between January 1998 and December 2007. Cumulative survival was analyzed using the Kaplan-Meier method. The log-rank test was used to compare the different groups, and multivariate Cox proportional hazards regression analyses were carried out to identify predictors of long-term, all-cause mortality.
RESULTS
A total of 191 consecutive patients with IE was evaluated (176 left-sided, 15 right-sided). Cardiac surgery was performed in 72% of cases, and the median follow up was 6.3 years. The cumulative long-term survival was 59% after 10 years of follow up, the main causes of death being congestive heart failure (28%) and different type of malignancy (17%). Age- and gender-matched survival in the general population was 98%, 92%, and 80% after follow up periods of one, five, and ten years, respectively. The main predictor of long-term mortality was cancer, while surgery had a positive effect on long-term survival.
CONCLUSION
Despite diagnostic and therapeutic advances, IE is associated with a high long-term mortality. Compared to the general Dutch population, the survival of patients with IE was significantly lower. Even in the event of IE being cured, the survival of these patients may be diminished compared to that of the general population. Hence, a careful follow up of these patients is warranted.