Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study
Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study
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DOI：
10.1093/eurheartj/ehl427
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发表时间：
2007-01-01
影响因子：
39.3
通讯作者：
Peetermans, Willy E.
中科院分区：
文献类型：
--
作者：
Hill, Evelyn E.;Herijgers, Paul;Peetermans, Willy E.
目的分析感染性心内膜炎（IE） 6个月死亡率的流行病学、最佳治疗方法和预测因素。方法和结果一项前瞻性观察队列研究纳入了193例经修改的Duke标准确诊的IE发作203次的患者。34%的病例涉及人工瓣膜。33%的发作发生在医院。其中43%为葡萄球菌，26%为链球菌，17%为肠球菌。79%的发作至少发生一种并发症，63%的发作进行了手术干预。六个月死亡率为22%：葡萄球菌33%，肠球菌24%，链球菌8%。74%的手术禁忌症患者死亡，而无禁忌症的药物治疗为7%，手术治疗为16%。在多变量logistic回归中，6个月死亡率的预测因子为年龄（P = 0.03）、致病微生物（P = 0.04）和治疗组（P < 0.001）。结论与旧系列相比，我们观察到更多的人工瓣膜IE，院内IE和手术。优势微生物为金黄色葡萄球菌和粪肠球菌。年龄、葡萄球菌和手术禁忌症预测6个月死亡率。近一半的死亡病例有手术禁忌症。6个月死亡率在接受手术治疗的患者与接受无手术禁忌症的患者之间没有显著差异。
Aims The aim here is to analyse epidemiology, optimal treatment, and predictors of 6-month mortality in infective endocarditis (IE).Methods and results A prospective observational cohort study included 193 patients with 203 episodes of definite IE by the modified Duke criteria. Thirty-four percent of episodes involved prosthetic valves. Thirty-three percent of episodes were nosocomial. Forty-three percent included staphylococci, 26% streptococci, and 17% enterococci. At least one complication occurred in 79% of the episodes and 63% had surgical intervention. Six-month mortality was 22%: 33% for staphylococci, 24% for enterococci, and 8% for streptococci. Seventy-four percent of patients with a contraindication to surgery died when compared with 7% with medical treatment without a contraindication and 16% with surgical treatment. In multivariable logistic regression, predictors of 6-month mortality were age (P = 0.03), the causative microorganism (P = 0.04), and treatment group (P < 0.001).Conclusion Compared with older series, we observed more prosthetic valve IE, nosocomial IE, and surgery. Staphylococcus aureus and Enterococcus faecalis were predominant microorganisms. Age, staphylococci, and a contraindication to surgery predicted 6-month mortality. Nearly half of deaths had a contraindication to surgery. Six-month mortality did not differ significantly between patients who received surgical treatment as against those who received medical treatment without a contraindication to surgery.