Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort

被引:61
作者
Galvez-Acebal, Juan [1 ]
Rodriguez-Bano, Jesus
Martinez-Marcos, Francisco J. [2 ]
Reguera, Jose M. [3 ]
Plata, Antonio [3 ]
Ruiz, Josefa [4 ]
Marquez, Manuel [4 ]
Lomas, Jose M. [2 ]
de la Torre-Lima, Javier [5 ]
Hidalgo-Tenorio, Carmen [6 ]
de Alarcon, Aristides [7 ]
机构
[1] Univ Hosp Virgen Macarena, Infect Dis Sect, Seville, Spain
[2] Gen Hosp Juan Ramon Jimenez, Infect Dis Unit, Huelva, Spain
[3] Univ Hosp Carlos Haya, Infect Dis Serv, Malaga, Spain
[4] Univ Hosp Virgen Victoria, Infect Dis Sect, Malaga, Spain
[5] Hosp Costa Sol, Internal Med Serv, Marbella, Spain
[6] Univ Hosp Virgen Nieves, Infect Dis Sect, Granada, Spain
[7] Univ Hosp Virgen Rocio, Infect Dis Serv, Seville, Spain
关键词
PROSTHETIC VALVE ENDOCARDITIS; INFECTIVE ENDOCARDITIS; INTERNATIONAL COLLABORATION; MERGED DATABASE; MORTALITY; SURGERY; RISK; SEPSIS; MANIFESTATIONS; PREDICTORS;
D O I
10.1186/1471-2334-10-17
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Despite medical advances, mortality in infective endocarditis (IE) is still very high. Previous studies on prognosis in IE have observed conflicting results. The aim of this study was to identify predictors of in-hospital mortality in a large multicenter cohort of left-sided IE. Methods: An observational multicenter study was conducted from January 1984 to December 2006 in seven hospitals in Andalusia, Spain. Seven hundred and five left-side IE patients were included. The main outcome measure was in-hospital mortality. Several prognostic factors were analysed by univariate tests and then by multilogistic regression model. Results: The overall mortality was 29.5% (25.5% from 1984 to 1995 and 31.9% from 1996 to 2006; Odds Ratio 1.25; 95% Confidence Interval: 0.97-1.60; p = 0.07). In univariate analysis, age, comorbidity, especially chronic liver disease, prosthetic valve, virulent microorganism such as Staphylococcus aureus, Streptococcus agalactiae and fungi, and complications (septic shock, severe heart failure, renal insufficiency, neurologic manifestations and perivalvular extension) were related with higher mortality. Independent factors for mortality in multivariate analysis were: Charlson comorbidity score (OR: 1.2; 95% CI: 1.1-1.3), prosthetic endocarditis (OR: 1.9; CI: 1.2-3.1), Staphylococcus aureus aetiology (OR: 2.1; CI: 1.3-3.5), severe heart failure (OR: 5.4; CI: 3.3-8.8), neurologic manifestations (OR: 1.9; CI: 1.2-2.9), septic shock (OR: 4.2; CI: 2.3-7.7), perivalvular extension (OR: 2.4; CI: 1.3-4.5) and acute renal failure (OR: 1.69; CI: 1.0-2.6). Conversely, Streptococcus viridans group etiology (OR: 0.4; CI: 0.2-0.7) and surgical treatment (OR: 0.5; CI: 0.3-0.8) were protective factors. Conclusions: Several characteristics of left-sided endocarditis enable selection of a patient group at higher risk of mortality. This group may benefit from more specialised attention in referral centers and should help to identify those patients who might benefit from more aggressive diagnostic and/or therapeutic procedures.
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页数:8
相关论文
共 38 条
[1]  
Anguita M., 2006, Rev Esp Cardiol, V58, P1188
[2]   Hospital-acquired infective endocarditis: Should the definition be broadened? [J].
Ben-Ami, R ;
Giladi, M ;
Carmeli, Y ;
Orni-Wasserlauf, R ;
Siegman-Ingra, Y .
CLINICAL INFECTIOUS DISEASES, 2004, 38 (06) :843-850
[3]   AMERICAN-COLLEGE OF CHEST PHYSICIANS SOCIETY OF CRITICAL CARE MEDICINE CONSENSUS CONFERENCE - DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS [J].
BONE, RC ;
BALK, RA ;
CERRA, FB ;
DELLINGER, RP ;
FEIN, AM ;
KNAUS, WA ;
SCHEIN, RMH ;
SIBBALD, WJ ;
ABRAMS, JH ;
BERNARD, GR ;
BIONDI, JW ;
CALVIN, JE ;
DEMLING, R ;
FAHEY, PJ ;
FISHER, CJ ;
FRANKLIN, C ;
GORELICK, KJ ;
KELLEY, MA ;
MAKI, DG ;
MARSHALL, JC ;
MERRILL, WW ;
PRIBBLE, JP ;
RACKOW, EC ;
RODELL, TC ;
SHEAGREN, JN ;
SILVER, M ;
SPRUNG, CL ;
STRAUBE, RC ;
TOBIN, MJ ;
TRENHOLME, GM ;
WAGNER, DP ;
WEBB, CD ;
WHERRY, JC ;
WIEDEMANN, HP ;
WORTEL, CH .
CRITICAL CARE MEDICINE, 1992, 20 (06) :864-874
[4]   Infective endocarditis -: A prospective study at the end of the twentieth century -: New predisposing conditions, new etiologic agents, and still a high mortality [J].
Bouza, E ;
Menasalvas, A ;
Muñoz, P ;
Vasallo, FJ ;
Moreno, MD ;
Fernández, MAG .
MEDICINE, 2001, 80 (05) :298-307
[5]   Changing patient characteristics and the effect on mortality in endocarditis [J].
Cabell, CH ;
Jollis, JG ;
Peterson, GE ;
Corey, GR ;
Anderson, DJ ;
Sexton, DJ ;
Woods, CW ;
Reller, LB ;
Ryan, T ;
Fowler, VG .
ARCHIVES OF INTERNAL MEDICINE, 2002, 162 (01) :90-94
[6]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[7]   Prognostic factors in 61 cases of Staphylococcus aureus prosthetic valve infective endocarditis from the international collaboration on endocarditis merged database [J].
Chirouze, C ;
Cabell, CH ;
Fowler, VG ;
Khayat, N ;
Olaison, L ;
Miro, JM ;
Habib, G ;
Abrutyn, E ;
Eykyn, S ;
Corey, GR ;
Selton-Suty, C ;
Hoen, B .
CLINICAL INFECTIOUS DISEASES, 2004, 38 (09) :1323-1327
[8]   Perivalvular abscesses associated with endocarditis - Clinical features and prognostic factors of overall survival in a series of 233 cases [J].
Choussat, R ;
Thomas, D ;
Isnard, R ;
Michel, PL ;
Lung, B ;
Hanania, G ;
Mathieu, P ;
David, M ;
de Chaumaray, TD ;
De Gevigney, G ;
Le Breton, H ;
Logeais, Y ;
Pierre-Justin, E ;
de Riberolles, C ;
Morvan, Y ;
Bischoff, N .
EUROPEAN HEART JOURNAL, 1999, 20 (03) :232-241
[9]   Early predictors of in-hospital death in infective endocarditis [J].
Chu, VH ;
Cabell, CH ;
Benjamin, DK ;
Kuniholm, EF ;
Fowler, VG ;
Engemann, J ;
Sexton, DJ ;
Corey, GR ;
Wang, A .
CIRCULATION, 2004, 109 (14) :1745-1749
[10]  
de Isla LP, 2003, REV ESP CARDIOL, V56, P794, DOI 10.1157/13050334