Prognostic implications of a negative echocardiography in patients with infective endocarditis

被引:11
|
作者
Vicent, Lourdes [1 ]
Gonzalez Saldivar, Hugo [1 ]
Bouza, Emilio [2 ]
Munoz, Patricia [2 ]
Cuerpo, Gregorio [3 ]
de Alarcon, Aristides [4 ]
Vidal, Barbara [5 ]
Cobo, Manuel [6 ]
Angel Goenaga, Miguel [7 ]
Carrasco-Chinchilla, Fernando [8 ]
Montejo, Miguel [9 ]
Galvez-Acebal, Juan [10 ]
Hidalgo-Tenorio, Carmen [11 ]
Vinuesa-Garcia, David [12 ]
Martinez-Selles, Manuel [1 ,13 ,14 ]
机构
[1] Hosp Gen Univ Gregorio Maranon, CIBERCV, Serv Cardiol, Madrid, Spain
[2] Univ Complutense, Hosp Gen Univ Gregorio Maranon, Serv Microbiol Clin & Enfermedades Infecciosas, Madrid, Spain
[3] Hosp Gen Univ Gregorio Maranon, Serv Cirugia Cardiaca, Madrid, Spain
[4] Univ Seville, Serv Microbiol Clin Enfermedades Infecciosas & Me, Inst Biomed Sevilla IBIS, CSIC,Hosp Virgen del Rocio & Virgen Macarena, Seville, Spain
[5] Univ Barcelona, Hosp Clin IDIBAPS, Serv Cardiol, Barcelona, Spain
[6] Hosp Univ Marques de Valdecilla, Serv Cardiol, Santander, Spain
[7] Hosp Univ Donosti, Serv Enfermedades Infecciosas, San Sebastian, Spain
[8] Hosp Virgen de la Victoria, Unidad Gest Clin Corazon, Malaga, Spain
[9] Univ Basque Country, Hosp Univ Cruces, Unidad Enfermedades Infecciosas, Bilbao, Spain
[10] Univ Seville, Inst Biomed Sevilla, Unidad Enfermedades Infecciosas, IBIS,Hosp Univ Virgen Macarena,CSIC, Seville, Spain
[11] Complejo Hosp Granada, Hosp Univ Virgen de las Nieves, Serv Enfermedades Infecciosas, Granada, Spain
[12] Hosp Clin San Cecilio, Serv Med Interna & Enfermedades Infecciosa, Granada, Spain
[13] Univ Complutense, Madrid, Spain
[14] Univ Europea, Madrid, Spain
关键词
Infective endocarditis; Echocardiography; Vegetation; Perivalvular complications; Prognosis; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; CLINICAL-FEATURES; DUKE CRITERIA; DIAGNOSIS; PREDICTORS; SURGERY; DEATH; RISK; MORTALITY; ASSOCIATION;
D O I
10.1016/j.ejim.2018.01.033
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Echocardiography plays an important role in infective endocarditis (IE) diagnosis according with the modified Duke criteria. We evaluated the implications of a positive echocardiography in the prognosis of a cohort of patients with IE. Methods: Prospective multicentre study in 31 Spanish centres. From January 2008 to September 2016, 3467 patients were included (2765 definite IE, 702 possible IE). The main outcome was in-hospital mortality. Echocardiography diagnosis was based on modified Duke criteria for the diagnosis of IE. Results: Median age was 69 years (interquartile range: 57-77 years). Comorbidity was high (mean Charlson index 4.7 +/- 2.8). Transoesophageal echocardiography was performed in 2680 (77.3%). The overall inhospital mortality rate was 26.7%. Univariate analysis showed that, in patients with definite IE, inhospital mortality was similar in patients with positive and negative echocardiography (27.7% vs. 24.6%, respectively, p = 0.121). In possible IE these figures were 27.5% vs. 16.7%, respectively, p < 0.001. Complications (cardiac and extra-cardiac [embolic, immunological, and septic shock]) were more frequent with positive than with negative echocardiography, regardless of clinical suspicion (definite IE 35.5% vs. 16.8%, respectively, p < 0.001; possible IE 20.8% vs. 7.6%, respectively, p < 0.001). Positive echocardiography was a predictor of inhospital death by logistic regression modelling, after adjusting for confounders, definite IE (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.02-1.76, p = 0.036), possible IE (OR 1.59, 95% CI 1.02-2.45, p = 0.036). Conclusions: A positive echocardiography in patients with IE is associated with increased inhospital mortality, in addition to other clinical factors and comorbidities.
引用
收藏
页码:40 / 48
页数:9
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