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Kumar A, Anstey C, Tesar P, Shekar K. Risk Factors for Mortality in Patients Undergoing Cardiothoracic Surgery for Infective Endocarditis. Ann Thorac Surg 2019; 108:1101-1106. [PMID: 31276645 DOI: 10.1016/j.athoracsur.2019.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/20/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study aimed to identify risk factors associated with mortality of patients who undergo cardiac surgery for infective endocarditis. METHODS A retrospective review was performed of patients with infective endocarditis who underwent cardiac surgery at a quaternary Australian hospital between 2004 and 2014. Patient data were collected and prospectively analyzed. RESULTS In all, 465 patients underwent surgery during the study period, with 30 deaths (6.45%). Factors independently associated with in-hospital mortality were increasing age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01 to 1.07; P = .009), active bacterial endocarditis at time of operation (OR 4.91; 95% CI, 1.01 to 23.8; P = .048), preoperative invasive positive pressure ventilation (OR 3.65; 95% CI, 1.18 to 11.27; P = .025), increasing cardiopulmonary bypass time (OR 1.01; 95% CI, 1.006 to 1.014; P < .001), and increasing European System for Cardiac Operative Risk Evaluation score (OR 21.73; 95% CI, 2.12 to 223.11; P < .01). CONCLUSIONS The in-hospital mortality of patients with infective endocarditis remains significant, with potential risk factors including increasing age, active bacterial endocarditis, preoperative invasive positive pressure ventilation, increasing cardiopulmonary bypass time, and high European System for Cardiac Operative Risk Evaluation score.
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Affiliation(s)
- Aashish Kumar
- Department of Intensive Care, Mater Hospital, Brisbane, Queensland, Australia.
| | - Chris Anstey
- Department of Intensive Care, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Peter Tesar
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Kiran Shekar
- Department of Intensive Care, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Liu Y, Zhang H, Liu Y, Han Q, Tang Y, Zhao L, Qiao F, Xu Z, Yu M, Yuan Z. Risk factors and short-term prognosis of preoperative renal insufficiency in infective endocarditis. J Thorac Dis 2018; 10:3679-3688. [PMID: 30069366 DOI: 10.21037/jtd.2018.06.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The incidence of postoperative complications and the in-hospital mortality rate of infective endocarditis (IE) complicated with renal insufficiency are relatively high. This study aimed to analyze the clinical features, etiological characteristics, diagnosis and treatment, and prognosis of IE with renal insufficiency and to explore the risk factors for renal damage. Methods IE patients undergoing valvular surgery between 2008 and 2017 in two cardiac centers were retrospectively analyzed. They were divided into renal insufficiency (RI) [endogenous creatinine clearance rate (Ccr) <60 mL/min/1.73 m2] and normal renal function (NRF) (Ccr ≥60 mL/min/1.73 m2) groups. The disease conditions at admission, etiology, treatment, and prognosis were compared between the two groups. Multivariate regression analysis was performed for the related factors. Results A total of 8,055 cases of valvular surgery was performed during the study period. We analyzed 401 IE patients [average age 43.9±15 years; RI, n=56 (14%); NRF, n=345 (86%)], after the exclusion of 2 patients with primary glomerulonephritis. RI patients showed higher perioperative mortality (14.3% vs. 4.5%, P=0.042) and streptococcal infection (71.4% vs. 43.8%, P=0.001) rates. The RI group was also older and had worse heart function, greater decreases in hemoglobin and platelet levels, a higher rate of prosthetic valve involvement, more cases of postoperative dialysis, and worse prognosis (all P<0.05). Binary logistic multivariate regression analysis showed that the incidence of streptococcal infection [odds ratio (OR) =4.271, 95% confidence interval (CI), 1.846-9.884; P=0.001], age ≥51 years (OR =5.138, 95% CI, 2.258-11.694; P<0.001), and New York Heart Association (NYHA) functional class III-IV (OR =10.768, 95% CI, 2.417-47.972; P=0.002) were independent risk factors for preoperative renal insufficiency. Conclusions IE patients with preoperative renal insufficiency had a high mortality rate and poor prognosis, with streptococcal infection predisposing to a higher risk of renal insufficiency. Moreover, older the age and worse heart function in IE resulted in a greater risk for renal insufficiency.
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Affiliation(s)
- Yang Liu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Hang Zhang
- Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical University, Shanghai 200080, China.,Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Yaoyang Liu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Qingqi Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yangfeng Tang
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Libo Zhao
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Min Yu
- Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical University, Shanghai 200080, China.,Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Zhongxiang Yuan
- Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical University, Shanghai 200080, China.,Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
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Shu Y, Yu S, Zha L, Fu P, Cui T. Catheter-related fungal endocarditis caused by Candida parapsilosis in a hemodialysis patient. Hemodial Int 2017; 21:E66-E68. [PMID: 28418628 DOI: 10.1111/hdi.12566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fungal endocarditis (FE) is commonly regarded as a rare but fatal disease. The incidence of infective endocarditis (IE) in hemodialysis (HD) patients is thought to be obviously higher than that in the general population. Moreover, IE occurs more likely in HD patients with catheters. With the increase of HD population and extensive use of catheters in HD patients, FE, as a special form of IE, may increase and bring new challenges to clinicians. We reported a case of FE associated with catheter infection in a 44-year-old woman on HD. The risk factors and treatment strategies of FE in HD patients were discussed.
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Affiliation(s)
- Ying Shu
- Department of Nephrology, Kidney Research Institution, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shaobin Yu
- Department of Nephrology, Kidney Research Institution, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ling Zha
- Department of Nephrology, Kidney Research Institution, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ping Fu
- Department of Nephrology, Kidney Research Institution, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Tianlei Cui
- Department of Nephrology, Kidney Research Institution, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Department of Intervention Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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