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Yang A, Tan C, Daneman N, Hansen MS, Habib G, Salaun E, Lavoute C, Hubert S, Adhikari NKJ. Clinical and echocardiographic predictors of embolism in infective endocarditis: systematic review and meta-analysis. Clin Microbiol Infect 2018; 25:178-187. [PMID: 30145401 DOI: 10.1016/j.cmi.2018.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/30/2018] [Accepted: 08/11/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Prediction of embolic events (EEs) in infective endocarditis (IE) could inform clinical decisions, such as surgical timing. We conducted a systematic review to more precisely define associations between risk factors and EEs. METHODS We searched two bibliographic databases (1994-2018) for observational studies that reported EEs in IE patients and considered clinical, microbiological or echocardiographic risk factors. Studies that did not use Duke criteria or only investigated a subset of IE patients were excluded. Study quality was assessed using the Newcastle-Ottawa scale. A pooled risk ratio (RR) for each risk factor was estimated using random-effects models; statistical heterogeneity was estimated using I2. RESULTS Of 3862 unique citations, 47 cohort studies (11 215 IE cases) were included; 54 risk factors were analysed in at least two studies, with nine studies reporting other individual factors. Most studies were of high methodological quality. Major predictors of EEs were intravenous drug use (RR 1.69, 95% CI 1.32-2.17; I2 = 46%), Staphylococcus aureus infection (RR 1.64, 95% CI 1.45-1.86, I2 = 32%), mitral valve vegetation (RR 1.24, 95% CI 1.11-1.37, I2 = 30%), and vegetation size >10 mm (RR 1.87, 95% CI 1.57-2.21, I2 = 48%). EE risk was also higher with human immunodeficiency virus, chronic liver disease, elevated C-reactive protein, Staphylococcus spp. infection, vegetation presence, and multiple, mobile or prosthetic mechanical valve vegetation, and lower with Streptococcus spp. infection. Most findings were unchanged in sensitivity analyses that removed studies with pulmonary EEs from the outcome. CONCLUSIONS Given the serious consequences of embolism, surgical evaluation may be considered in patients with these risk factors.
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Affiliation(s)
- A Yang
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - C Tan
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - N Daneman
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - M S Hansen
- Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - G Habib
- Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, Cardiology Department, Marseille, France; Aix-Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - E Salaun
- Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, Cardiology Department, Marseille, France; Aix-Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - C Lavoute
- Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, Cardiology Department, Marseille, France; Aix-Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - S Hubert
- Assistance Publique-Hôpitaux de Marseille, La Timone Hospital, Cardiology Department, Marseille, France; Aix-Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - N K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.
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Ba DM, Mboup MC, Zeba N, Dia K, Fall AN, Fall F, Fall PD, Gning SB. Infective endocarditis in Principal Hospital of Dakar: a retrospective study of 42 cases over 10 years. Pan Afr Med J 2017; 26:40. [PMID: 28451018 PMCID: PMC5398261 DOI: 10.11604/pamj.2017.26.40.10020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/22/2016] [Indexed: 12/19/2022] Open
Abstract
Infective Endocarditis (IE) is an endocardial infection usually caused by bacteria that affects not only the native heart valves but also, with increasing frequency intravascular implanted devices and congenital heart diseases. Despite medical advances, IE remains a life-threatening disease with substantial morbidity and mortality. In Africa, its diagnosis and treatment are still a major challenge in clinical practice. The objective of this work was to study the epidemiological, clinical features, diagnostic techniques currently used in medical practice and the range of micro-organisms that are responsible. This was a retrospective study done at Principal Hospital of Dakar. We include all patients who were admitted with clinical manifestations of definite or possible IE according to the extended DUKE criteria between January 1st, 2005 and December 31st, 2014. We collected and analyzed epidemiological, clinical, paraclinical and outcomes data of 42 patients. Hospital prevalence of IE was 0.078% (42/53711). The mean age was 27.5+/- 18 years with a sex ratio (M/F) of 0.55. IE were more common in patients with damaged or abnormal heart valves (78.6%) and in thoses with underlying structural defects (14.3%). The most common presenting symptoms were fever (90%) and cardiac murmurs (81%). Extracardiac clinical manifestations were very rare. The usual laboratory parameters of inflammation were elevated in 90% of patients. Blood cultures were negative in 50% of cases and positive in 21.4%. The main organism found was Staphylococcus aureus. Echocardiography found vegetations in 95.2% of cases, chamber enlargement in 73.8% and mitral regurgiation in 83.3%. Broad-spectrum penicillins including ampicillin and gentamycine were used for all patients. Major complications were heart failure (47.6%). Strokes and cerebral abcess (23.8%) and Vascular emboli 14.3%. Hospital mortality was 31%. IE remains a life-threatening disease with hight mortality despites improved techniques of diagnosis and modern antibiotics.
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Affiliation(s)
- Djibril Marie Ba
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | | | - Nafissatou Zeba
- Department of Internal Medicine, Principal Hospital of Dakar, Dakar, Senegal
| | - Khadidiatou Dia
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Awa Ndaw Fall
- Department of Internal Medicine, Principal Hospital of Dakar, Dakar, Senegal
| | - Fatou Fall
- Department of Internal Medicine, Principal Hospital of Dakar, Dakar, Senegal
| | - Pape Diadie Fall
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Sara Boury Gning
- Department of Internal Medicine, Principal Hospital of Dakar, Dakar, Senegal
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