Left-sided infective endocarditis in patients with liver cirrhosis.

Autor: Ruiz-Morales J; UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. Electronic address: mjruizm@gmail.com., Ivanova-Georgieva R; Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. Electronic address: drradabg@yahoo.com., Fernández-Hidalgo N; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: nufernan@gmail.com., García-Cabrera E; UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Electronic address: emiliogcabrera@gmail.com., Miró JM; Hospital Clinic - IDIBAPS, Servicio de Enfermedades Infecciosas y Microbiología, Universidad de Barcelona, Barcelona, Spain. Electronic address: jmmiro@ub.edu., Muñoz P; Servicio de Microbiología y Enfermedades infecciosas, H. Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: pmunoz@micro.hggm.es., Almirante B; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: benitoalmirante@gmail.com., Plata-Ciézar A; UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital General Universitario, Málaga, Spain. Electronic address: nonispc@hotmail.com., González-Ramallo V; Unidad de Hospitalización a Domicilio, H. Universitario Gregorio Marañón, Madrid, Spain. Electronic address: vgramallo@orange.es., Gálvez-Acebal J; UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain. Electronic address: jga@us.es., Fariñas MC; Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain. Electronic address: mcfarinas@humv.es., Bravo-Ferrer JM; Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain. Electronic address: josem.bravoferrer.acosta@hotmail.com., Goenaga-Sánchez MA; Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain. Electronic address: goenagasanchez@gmail.com., Hidalgo-Tenorio C; Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain. Electronic address: chidalgo72@gmail.com., Goikoetxea-Agirre J; Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain. Electronic address: anejosune.goikoetxeaagirre@osakidetza.net., de Alarcón-González A; UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Electronic address: aa2406ge@yahoo.es.
Jazyk: angličtina
Zdroj: The Journal of infection [J Infect] 2015 Dec; Vol. 71 (6), pp. 627-41. Date of Electronic Publication: 2015 Sep 25.
DOI: 10.1016/j.jinf.2015.09.005
Abstrakt: Objective: To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery.
Methods: Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals.
Results: A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery.
Conclusions: Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
(Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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