目的:先天性心脏病(CHD)患者是感染性心内膜炎(IE)的高危亚组,需要量身定制的预防和治疗策略。然而,全面的全国数据,比较有和无冠心病患者的IE特征和结局,包括孩子,是稀疏的。本研究旨在解决这一知识差距。
方法:使用丹麦全国注册,从1977年到2021年的所有IE患者都被确定并分层是否诊断为冠心病,不管它的复杂性。入院前和入院期间的特征以及相关结果(即住院死亡率,1年死亡率,和10年死亡率,和IE复发)进行组间比较。
结果:总计,确定了14040例IE患者,包括895例(6.4%)冠心病患者。患者与没有冠心病的患者在IE诊断时更年轻(中位年龄38.8岁vs.70.7年),减少合并症,入院时更频繁地接受心脏手术(35.7%vs.23.0%,P<.001)。值得注意的是,76%的IE<18岁患者患有冠心病。两组间与IE相关的菌血症不同:链球菌(29.9%)在冠心病患者中最常见,非冠心病患者中金黄色葡萄球菌(29.9%)。冠心病患者的住院死亡率累积发生率显着降低(5.7%vs.17.0%,P<.001)和1年死亡率(9.9%vs.31.8%,P<.001)与无冠心病者相比。IE复发的10年累积发生率在组间相似(13.0%和13.9%,P=.61)。
结论:与没有冠心病的患者相比,发生IE的冠心病患者表现出明显的特征和改善的长期预后。值得注意的是,大多数IE儿童和青少年患有基础冠心病。
OBJECTIVE: Patients with congenital heart disease (CHD) form a high-risk subgroup for infective endocarditis (IE), necessitating tailored prevention and treatment strategies. However, comprehensive nationwide data comparing IE characteristics and outcomes in patients with and without CHD, including children, are sparse. This study aims to address this gap in knowledge.
METHODS: Using Danish nationwide registries, all patients with IE from 1977 to 2021 were identified and stratified on whether they had a diagnosis of CHD, regardless of its complexity. Characteristics prior to and during admission as well as associated outcomes (i.e. in-hospital mortality, 1-year mortality, and 10-year mortality, and IE recurrence) were compared between groups.
RESULTS: In total, 14 040 patients with IE were identified, including 895 (6.4%) with CHD. Patients with vs. without CHD were younger at the time of IE diagnosis (median age 38.8 vs. 70.7 years), less comorbid, and more frequently underwent cardiac surgery during admission (35.7% vs. 23.0%, P < .001). Notably, 76% of patients with IE < 18 years of age had CHD. The IE-related bacteraemia differed between groups: Streptococci (29.9%) were the most common in patients with CHD, and Staphylococcus aureus (29.9%) in patients without CHD. Patients with CHD had a significantly lower cumulative incidence of in-hospital mortality (5.7% vs. 17.0%, P < .001) and 1-year mortality (9.9% vs. 31.8%, P < .001) compared with those without CHD. The 10-year cumulative incidence of IE recurrence was similar between groups (13.0% and 13.9%, P = .61).
CONCLUSIONS: Patients with CHD who develop IE exhibit distinct characteristics and improved long-term outcomes compared with patients without CHD. Notably, the majority of children and adolescents with IE have underlying CHD.