左侧感染性心内膜炎患者死亡率的特征和危险因素：一项在大容量中心进行的前瞻性研究

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Archives of Cardiovascular Diseases Pub Date : 2025-05-30 DOI:10.1016/j.acvd.2025.04.045

C. Granger , C. Combacau , P. Devos , J. Farwati , E. Dhouieb , A. Srour , G. Lebreton , A. Bleibtreu , A. Gavaud , B. Rached , G. Montalescot , J. Silvain , G. Hekimian , N. Hammoudi

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引用次数: 0

摘要

背景：有效性心内膜炎（IE）与高死亡率相关。可获得的前瞻性数据很少，来自前瞻性队列的进一步知识可以帮助优化IE患者的预后。目的探讨某大容量中心左脑IE的特点及死亡率的影响因素。方法前瞻性纳入2020年9月15日至2024年4月30日在Pitié-Salpêtrière医院住院的所有左侧IE患者。分别评估人工瓣膜IE （PVE）和天然瓣膜IE （NVE）亚组住院死亡率的决定因素，使用多元逻辑回归模型，包括单因素分析中的任何协变量(P <；0.1)。结果共纳入317例患者，其中PVE 141例（44%），NVE 176例（56%）。中位年龄为68（58-76）岁，77%的患者为男性（表1）。70例（25%）患者需要首次入住重症监护病房（ICU）。在292例（92%）病例中，微生物被鉴定出来，链球菌、葡萄球菌或肠球菌是记录最多的细菌（82%）。24%的病例发现心脏脓肿，172例（54%）患者接受手术治疗。与PVE相比，NVE患者更年轻，金黄色葡萄球菌更常见，但脓肿数量和手术率相似。在PVE亚组中（表1），院内死亡的预测因子（24/ 141,17 %）为年龄(OR = 1.07；95%CI: 1.02-1.13)、心脓肿（OR = 2.9, 95%CI: 1.03-8.2）和严重瓣膜漏(OR = 3.4；95 ci: 1.03 - -11.3)。在NVE亚组中（表2），死亡预测因子（40/176,23%）为年龄(OR = 1.05；95%CI: 1.01-1.09)， HIV感染(OR = 22.5；95%CI: 1.4-374.6)，慢性酒精滥用(OR = 4.1；95%CI: 1.2-13.5)和首次入住ICU (OR = 3.7；95%CI: 1.4-9.7)（表2）。结论本组患者首发症状严重，多发合并症，死亡率高。死亡率的决定因素在PVE和NVE之间似乎有所不同。

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Characteristics and risk factors for mortality of patients managed for left-sided infective endocarditis: A prospective study in a high-volume center

Background

Infective endocarditis (IE) is associated with high mortality. Available prospective data are scarce, further knowledge from prospective cohorts could help optimize the prognosis of patients with IE.

Objectives

To describe the characteristics and determinants of mortality of left-sided IE in a high-volume center.

Methods

From September 15, 2020, to April 30, 2024, all hospitalized patients for left-sided IE at Pitié-Salpêtrière Hospital were prospectively included. Determinants of in-hospital mortality of prosthetic valve IE (PVE) and native valve IE (NVE) subgroups were assessed separately, using a multivariate logistic regression model including any covariate associated in univariate analysis (P < 0.1).

Results

A total of 317 patients were included, 141 (44%) with PVE and 176 (56%) with NVE. Median age was 68 (58–76) years and 77% of patients were male (Table 1). Initial admission in intensive care unit (ICU) was required for 70 (25%) patients. In 292 (92%) cases, the microorganism was identified, Streptococcus, Staphylococcus, or Enterococcus were the most documented germs (82%). A cardiac abscess was identified in 24% of cases and surgery was performed in 172 (54%) patients. Compared to PVE the patients with NVE were younger and Staphylococcus aureus was more frequently involved but the number of abscess and surgery rate were similar. In the PVE subgroup (Table 1), predictors of in-hospital death (24/141, 17%) were age (OR = 1.07; 95%CI: 1.02–1.13), cardiac abscess (OR = 2.9, 95%CI: 1.03–8.2) and severe valvular leak (OR = 3.4; 95CI: 1.03–11.3). In the NVE subgroup (Table 2), predictors of death (40/176, 23%) were age (OR = 1.05; 95%CI: 1.01–1.09), HIV infection (OR = 22.5; 95%CI: 1.4–374.6), chronic alcoholic abuse (OR = 4.1; 95%CI: 1.2–13.5) and initial ICU admission (OR = 3.7; 95%CI: 1.4–9.7) (Table 2).

Conclusion

In this cohort, patients had frequent severe initial presentation and multiple comorbidities with high mortality. Determinants of mortality seem to differ between PVE and NVE.

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来源期刊

Archives of Cardiovascular Diseases 医学-心血管系统

CiteScore

4.40

自引率

6.70%

发文量

审稿时长

34 days

期刊介绍： The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.