Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
| Autor: | Arístides de Alarcón, Manuel Márquez, Javier de la Torre-Lima, Francisco Javier Martínez-Marcos, J.M. Reguera, Jesús Rodríguez-Baño, Carmen Hidalgo-Tenorio, Antonio Plata, Josefa Ruiz, Juan Gálvez-Acebal, José Manuel Lomas |
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| Přispěvatelé: | Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI), [Galvez,J, Rodríguez,J] Infectious Diseases Section, University Hospital Virgen Macarena, Sevilla. Spain. [Martínez,FJ, Lomas,JM] Infectious Diseases Unit, General Hospital Juan Ramón Jiménez, Huelva. Spain. [Reguera,JM, Plata,A] Infectious Diseases Service, University Hospital Carlos Haya, Málaga, Spain. [Ruiz,J, Marquez,M] Infectious Diseases Section, University Hospital Virgen de la Victoria, Málaga, Spain. [de la Torre_Lima,J] Internal Medicine Service, Hospital Costa del Sol, Marbella, Spain. [Hidalgo,C] Infectious Diseases Section, University Hospital Virgen de las Nieves, Granada. Spain. [Alarcón,A]nfectious Diseases Service, University Hospital Virgen del Rocío, Sevilla, Spain, The study was supported by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III - FEDER, Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008). |
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Male
Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings] renal insufficiency Cohort Studies Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] neurologic manifestations Risk Factors Risk of mortality Hospital Mortality left-sided endocarditis Geographicals::Geographic Locations::Europe::Spain [Medical Subject Headings] Univariate analysis Endocarditis izquierda shock séptico Middle Aged Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Endocarditis Bacterial [Medical Subject Headings] Infectious Diseases perivalvular extension Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models Statistical::Logistic Models [Medical Subject Headings] Infective endocarditis Named Groups::Persons::Age Groups::Adolescent [Medical Subject Headings] Cohort Female Staphylococcus au Research Article Cohort study Adult insuficiencia renal medicine.medical_specialty Staphylococcus aureus Adolescent Named Groups::Persons::Age Groups::Adult::Young Adult [Medical Subject Headings] Analytical Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Analysis of Variance::Multivariate Analysis [Medical Subject Headings] Health Care::Health Care Quality Access and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings] lcsh:Infectious and parasitic diseases Young Adult Health Care::Environment and Public Health::Public Health::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies [Medical Subject Headings] Internal medicine manifestaciones neurológicas Health Care::Environment and Public Health::Public Health::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Hospital Mortality [Medical Subject Headings] medicine Humans Endocarditis lcsh:RC109-216 Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings] Aged business.industry extensión perivalvular Endocarditis Bacterial Odds ratio medicine.disease Comorbidity Surgery Logistic Models Spain Multivariate Analysis septic shock business |
| Zdroj: | BMC Infectious Diseases, Vol 10, Iss 1, p 17 (2010) BMC Infectious Diseases |
| Popis: | 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. Yes A pesar de los avances médicos, la mortalidad en la endocarditis infecciosa (EI) es todavía muy alto. Estudios previos sobre el pronóstico de IE han observado resultados contradictorios. El objetivo de este estudio fue identificar los factores predictivos de mortalidad hospitalaria en una cohorte multicéntrico de EI izquierda. Métodos.Un estudio observacional multicéntrico se realizó entre enero 1984-diciembre 2006 en siete hospitales de Andalucía, España. Setecientos y cinco del lado izquierdo es decir, pacientes fueron incluidos. La medida de resultado principal fue la mortalidad hospitalaria. Son varios los factores pronósticos fueron analizados por pruebas univariadas y luego por un modelo de regresión multilogistic. Resultados La mortalidad global fue del 29,5% (25,5% desde 1984 hasta 1995 y el 31,9% de 1996 a 2006; odds-ratio 1,25, IC 95%: 0,97-1,60, p = 0,07). En el análisis univariado, la edad, comorbilidad, enfermedad hepática crónica en especial, prótesis valvulares, microorganismos virulentos, como Staphylococcus aureus, Streptococcus agalactiae y los hongos, y las complicaciones (shock séptico, insuficiencia cardíaca grave, insuficiencia renal, manifestaciones neurológicas y extensión perivalvular) estaban relacionadas con una mayor mortalidad. Los factores independientes de mortalidad en el análisis multivariado fueron: puntuación de comorbilidad de Charlson (OR: 1.2, IC 95%: 1,1-1,3), la endocarditis protésica (OR: 1.9, IC: 1,2-3,1), la etiología de Staphylococcus aureus (OR: 2.1, IC: 1,3-3,5), insuficiencia cardíaca grave (OR: 5.4, IC: 03.03 a 08.08), manifestaciones neurológicas (OR: 1.9, IC: 1.2-2.9), shock séptico (OR: 4.2, IC: 2.3 a 7.7), la extensión perivalvular (OR: 2.4, IC: 1,3-4,5) y la insuficiencia renal aguda (OR: 1.69, IC: 1.0-2.6). Por el contrario, Streptococcus grupo viridans etiología (OR: 0.4, IC: 0,2-0,7) y el tratamiento quirúrgico (OR: 0.5, IC: 0.3-0.8) fueron los factores de protección. Conclusiones Varias características de la endocarditis izquierda permitir la selección de un grupo de pacientes con mayor riesgo de mortalidad. Este grupo puede beneficiarse de una mayor atención especializada en centros de referencia y debería ayudar a identificar a aquellos pacientes que podrían beneficiarse de procedimientos más agresivos de diagnóstico y / o terapéuticos. |
| Databáze: | OpenAIRE |
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