背景:主动脉瓣感染性心内膜炎(IE)与显著的发病率和死亡率相关。我们的目的是描述临床概况,主动脉瓣置换术(AVR)治疗的主动脉瓣IE患者与非感染性心脏瓣膜病行AVR对照组相比,短期和长期死亡率的危险因素和预测因子.
方法:在2008年1月至2013年12月之间,从斯堪的纳维亚半岛的三家拥有心胸设施的三级医院招募了170例接受AVR治疗的IE患者(暴露队列)和677例随机选择的非感染性AVR治疗的退行性主动脉瓣疾病患者(对照)。使用Cox回归模型估计粗略和调整后的风险比(HR)。
结果:IE队列的平均年龄为58.5±15.1岁(80.0%男性)。在平均7.8年(IQR5.1-10.8年)的随访期间,发生373例(44.0%)死亡:IE组81例(47.6%),对照组292例(43.1%)。与IE相关的独立危险因素为男性,以前的心脏手术,体重不足,丙型肝炎血清学阳性,肾功能衰竭,先前的伤口感染和牙科治疗(所有p<0.05)。IE与短期(≤30天)的风险增加相关(HR2.86,[1.36-5.98],p=0.005)和长期死亡率(HR2.03,[1.43-2.88],p<0.001)。在IE患者中,慢性阻塞性肺疾病(HR2.13),体重不足(HR4.47),肾衰竭(HR2.05),合并二尖瓣受累(HR2.37)和纵隔炎(HR3.98)是长期死亡率的独立预测因子.金黄色葡萄球菌是最普遍的微生物(21.8%),与早期死亡风险增加5.2倍相关。而肠球菌与长期死亡风险相关(HR1.78).
结论:在这项多中心病例对照研究中,与对照组相比,IE与短期和长期死亡率风险增加相关。应努力查明,并及时处理与承包IE相关的可修改风险因素,并减轻IE生存不良的预测因素。
BACKGROUND: Aortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease.
METHODS: Between January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models.
RESULTS: The mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36-5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43-2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78).
CONCLUSIONS: In this multicenter
case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.