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Koike M, Doi T, Morishita K, Uruno K, Kawasaki-Nabuchi M, Komuro K, Iwano H, Naraoka S, Nagahara D, Yuda S. Impact of Hemoglobin Level, White Blood Cell Count, Renal Dysfunction, and Staphylococcus as the Causative Organism on Prediction of In-Hospital Mortality from Infective Endocarditis. Int Heart J 2024; 65:199-210. [PMID: 38556331 DOI: 10.1536/ihj.23-360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Infective endocarditis (IE) is a highly fatal disease in cases of delayed diagnosis and treatment, although its incidence is low. However, there have been few single-center studies in which the risk of in-hospital death from IE was stratified according to laboratory findings on admission and the organism responsible for IE. In this study, a total of 162 patients who were admitted to our hospital during the period from 2009 to 2021, who were suspected of having IE according to the modified Duke classification, and for whom IE was confirmed by transesophageal echocardiography were retrospectively analyzed. Patients were observed for a mean-period of 43.7 days with the primary endpoint being in-hospital death. The in-hospital death group had a lower level of hemoglobin (Hb), higher white blood cell (WBC) count, lower level of estimated glomerular filtration rate (eGFR), and higher frequency of Staphylococcus being the causative agent than those in the non-in-hospital death group. In overall multivariate analysis, Hb, WBC count, eGFR, and Staphylococcus as the causative agent were identified to be significant prognostic determinants. IE patients with Hb < 10.6 g/dL, WBC count > 1.4 × 104/μL, eGFR < 28.1 mL/minute/1.7 m2, and Staphylococcus as the causative agent had significantly and synergistically increased in-hospital death rates compared to those in other IE patients. Low level of Hb, high WBC count, low eGFR, and Staphylococcus as the causative agent of IE were independent predictors of in-hospital mortality, suggesting that these 4 parameters may be combined to additively stratify the risk of in-hospital mortality.
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Affiliation(s)
| | - Takahiro Doi
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Kosuke Uruno
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Kaoru Komuro
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital
| | | | - Satoshi Yuda
- Department of Cardiology, Teine Keijinkai Hospital
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2
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Clinical Presentation and Risk Factors of Infective Endocarditis in the Elderly: A Systematic Review. J Pers Med 2023; 13:jpm13020296. [PMID: 36836530 PMCID: PMC9966560 DOI: 10.3390/jpm13020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Infective endocarditis (IE) is a bacterial infection with high morbidity and mortality rates, particularly among the elderly. This systematic review was conducted to determine the clinical characteristics of IE in older adults and the risk factors that could lead to adverse outcomes. The research employed three databases (PubMed, Wiley, and Web of Science), with a primary search for studies that have described cases of IE in patients older than 65 years. From a total of 555 articles, 10 were selected for inclusion in the current study, comprising a total of 2222 patients with a confirmed diagnosis of IE. The primary findings were an increased incidence of staphylococcal and streptococcal infections (33.4% and32.0%, respectively), an increased prevalence of comorbidities, namely, cardiovascular disease, diabetes, and cancer, and a significantly greater mortality risk than the younger group. Regarding mortality risks, the pooled odds ratio for cardiac disorders was OR = 3.81, septic shock OR = 8.22, renal complications OR = 3.75, and advancing age OR = 3.54 were most frequently mentioned. Taking into consideration the fact that the majority of the elderly population suffers from significant complications and is unable to undergo surgery due to an increased risk of complications after the procedure, it is imperative that effective treatment methods should be investigated.
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3
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Lin KP, Yeh TK, Chuang YC, Wang LA, Fu YC, Liu PY. Blood Culture Negative Endocarditis: A Review of Laboratory Diagnostic Approaches. Int J Gen Med 2023; 16:317-327. [PMID: 36718144 PMCID: PMC9884005 DOI: 10.2147/ijgm.s393329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Infective endocarditis is a potentially fatal condition, and identifying the pathogen is crucial to optimizing antibiotic treatment. While a blood culture takes time and may yield negative results, it remains the gold standard for diagnosis, blood culture-negative endocarditis, which accounts for up to 20% of infective endocarditis cases, poses a clinical challenge with increasing mortality. To better understand the etiology of blood culture-negative infective endocarditis, we reviewed non-culture-based strategies and compared the results. Serology tests work best in limited pathogens, such as Coxiella burnetii and Bartonella infections. Most of the pathogens identified by broad-range PCR tests are Streptococcus spp, Staphylococcus spp and Propionibacterium spp. adding specific real-time PCR assays to the systematic PCR testing of patients with blood culture-negative endocarditis will increase the efficiency of diagnosis. Recently, metagenomic next-generation sequencing has also shown promising results.
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Affiliation(s)
- Kuan-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ting-Kuang Yeh
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,Genomic Center for Infectious Diseases, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chuan Chuang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Li-An Wang
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Ching Fu
- Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Correspondence: Yun-Ching Fu; Po-Yu Liu, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Blvd, Xitun District, Taichung City, 40705, Taiwan, Tel +886-4-2359-2525 ext.3110, Fax +886-4-2359-5046, Email ;
| | - Po-Yu Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan,Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan,Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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4
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Kouijzer JJP, Noordermeer DJ, van Leeuwen WJ, Verkaik NJ, Lattwein KR. Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies. Front Cell Dev Biol 2022; 10:995508. [PMID: 36263017 PMCID: PMC9574252 DOI: 10.3389/fcell.2022.995508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening microbial infection of native and prosthetic heart valves, endocardial surface, and/or indwelling cardiac device. Prevalence of IE is increasing and mortality has not significantly improved despite technological advances. This review provides an updated overview using recent literature on the clinical presentation, diagnosis, imaging, causative pathogens, treatment, and outcomes in native valve, prosthetic valve, and cardiac device-related IE. In addition, the experimental approaches used in IE research to improve the understanding of disease mechanisms and the current diagnostic pipelines are discussed, as well as potential innovative diagnostic and therapeutic strategies. This will ultimately help towards deriving better diagnostic tools and treatments to improve IE patient outcomes.
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Affiliation(s)
- Joop J. P. Kouijzer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
- *Correspondence: Joop J. P. Kouijzer,
| | - Daniëlle J. Noordermeer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wouter J. van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kirby R. Lattwein
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Perez-Rivera JA, Armiñanzas C, Muñoz P, Kestler M, Pinilla B, Fariñas MC, Alvarez-Rodriguez I, Cuervo G, Rodriguez-Esteban A, de Alarcón A, Gutiérrez-Villanueva A, Pello-Lazaro A, Sellés MM. Comorbidity and Prognosis in Octogenarians with Infective Endocarditis. J Clin Med 2022; 11:jcm11133774. [PMID: 35807059 PMCID: PMC9267499 DOI: 10.3390/jcm11133774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Infective endocarditis (IE) in older patients is associated with a high morbidity, mortality, and functional impairment. The purpose of this study was to describe the current profile of IE in octogenarians and to analyze the prognostic impact of baseline comorbidities in this population. Methods. Patients ≥ 80 years and definite IE from the Spanish IE Prospective Database were included. The effect of Charlson Comorbidity Index (CCI) on in-hospital and 12-month mortality was analyzed. Results. From 726 patients, 357 (49%) had CCI ≥ 3 and 369 (51%) CCI < 3. A total of 265 patients (36.6%) died during hospital admission and 338 (45.5%) during 1-year follow-up. CCI ≥ 3 was an independent predictor of in-hospital and 1-year mortality (odds ratio 1.46, 95% confidence interval 1.07−1.99, p = 0.017; hazard ratio 1.34, 95% confidence interval 1.08−1.66, p = 0.007, respectively). Surgical management was less common in patients with high comorbidity (CCI ≥ 3 68 [19.0%] vs. CCI < 3 112 ((30.4%) patients, p < 0.01). From 443 patients with surgical indication, surgery was only performed in 176 (39.7%). Patients with surgical indication treated conservatively had higher mortality than those treated with surgery (in-hospital mortality: 147 (55.1%) vs. 55 (31.3%), p < 0.001), (1-year mortality: 172 (64.4%) vs. 68 [38.6%], p < 0.001). Conclusion. About half of octogenarians with IE had high comorbidity with CCI ≥ 3. CCI ≥ 3 was a strong independent predictor of in-hospital and 1-year mortality. Our data suggest that the underperformance of cardiac surgery in this group of patients might have a role in their poor prognosis.
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Affiliation(s)
- Jose-Angel Perez-Rivera
- Unidad Especializada de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario de Burgos, Universidad Isabel I, 09003 Burgos, Spain;
| | - Carlos Armiñanzas
- Servicio de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla IDIVAL, 39008 Santander, Spain;
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Martha Kestler
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
| | - Blanca Pinilla
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Maria-Carmen Fariñas
- Servicio de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla IDIVAL, CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Universidad de Cantabria, 39008 Santander, Spain;
| | - Ignacio Alvarez-Rodriguez
- Servicio de Enfermedades Infecciosas, Hospital Donostia, OSI Donostialdea, 20014 San Sebastián, Spain;
| | - Guillermo Cuervo
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, 08036 Barcelona, Spain;
| | | | - Aristides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain;
| | - Andrea Gutiérrez-Villanueva
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, 28222 Madrid, Spain;
| | - Ana Pello-Lazaro
- Servicio de Cardiología, Unidad de Hospitalización, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Manuel Martínez Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, 28040 Madrid, Spain
- Facultad de Medicina, Universidad Europea, 28670 Madrid, Spain
- Correspondence: ; Tel.: +34-91586-8293; Fax: +34-9158-6827
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Zhang X, Jin F, Lu Y, Ni F, Xu Y, Xia W. Clinical Characteristics and Risk Factors for in-Hospital Mortality in 240 Cases of Infective Endocarditis in a Tertiary Hospital in China: A Retrospective Study. Infect Drug Resist 2022; 15:3179-3189. [PMID: 35754785 PMCID: PMC9215907 DOI: 10.2147/idr.s362601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/23/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed (i) to investigate the clinical characteristics and risk factors related to in-hospital mortality in patients with infective endocarditis (IE) and (ii) to compare the differences in three age groups. Methods A total of 240 IE cases diagnosed using the modified Duke criteria between January 2016 and December 2019 were included and retrospectively studied. Patients were stratified into three age groups: < 50 y, 50–65 y, and > 65 y. Results The mean age of the patients was 51 ± 14 y, and 154 patients (64.2%) were male. In addition, 136 (56.7%) patients with IE had no previous cardiac disease. Congenital heart disease (CHD, 21.3%) was the most common underlying heart disease, followed by rheumatic heart disease (RHD, 8.8%). Streptococcus was found in 55 (22.9%) patients and was the most common causative pathogen, comprising 52.9% of all positive blood cultures. Echocardiography showed the presence of vegetations in 88.3% of cases and the predominant involvement of the left heart valves. Fever and cardiac murmur were the most frequent presentations, with no significant differences among age groups. Compared with younger patients, elderly patients had a lower operation rate and higher in-hospital mortality. The independent risk factors of in-hospital mortality were age > 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection. Conclusion CHD replaces RHD as the most common underlying heart disease in IE patients. Patients without previous cardiac disease are at increased risk of IE. Streptococcus is still the primary causative pathogen of IE. Elderly patients present with more comorbidities and complications, in addition to a more severe prognosis than younger patients. Age older than 65 y, intracranial infection, splenic embolization, cerebral hemorrhage, NYHA class III–IV, and prosthetic valve infection showed poorer in-hospital outcomes.
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Affiliation(s)
- Xiaohui Zhang
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Fei Jin
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Yanfei Lu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Fang Ni
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Yuqiao Xu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
| | - Wenying Xia
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, People's Republic of China
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Lemos LHB, Silva LRD, Correa MG, Golebiovski W, Weksler C, Garrido RQ, Barbosa GF, Lamas CDC. Infective Endocarditis in the Elderly: Distinct Characteristics. Arq Bras Cardiol 2021; 117:775-781. [PMID: 34709305 PMCID: PMC8528351 DOI: 10.36660/abc.20201134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/12/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
| | | | | | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Rafael Quaresma Garrido
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil.,Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ - Brasil
| | - Giovanna Ferraiuoli Barbosa
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil.,Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | - Cristiane da Cruz Lamas
- Universidade do Grande Rio (Unigranrio), Rio de Janeiro, RJ - Brasil.,Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil.,Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ - Brasil
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Ragnarsson S, Salto-Alejandre S, Ström A, Olaison L, Rasmussen M. Surgery Is Underused in Elderly Patients With Left-Sided Infective Endocarditis: A Nationwide Registry Study. J Am Heart Assoc 2021; 10:e020221. [PMID: 34558291 PMCID: PMC8649125 DOI: 10.1161/jaha.120.020221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Infective endocarditis is associated with higher mortality in elderly patients, but the role of surgery in this group has not been fully evaluated. The aim of this study was to assess outcomes of left‐sided infective endocarditis in elderly patients and to determine the influence of surgery on mortality in the elderly. Methods and Results A nationwide retrospective study was performed of 2186 patients with left‐sided infective endocarditis recorded in the SRIE (Swedish Registry of Infective Endocarditis), divided into patients aged <65 years (n=864), 65 to 79 years (n=806), and ≥80 years (n=516). Survival analysis was performed using the Swedish National Population Registry, and propensity score matching was applied to assess the effect of surgery on survival among patients of all ages. The rate of surgery decreased with increasing age, from 46% in the <65 group to 6% in the ≥80 group. In‐hospital mortality was 3 times higher in the ≥80 group compared with the <65 group (23% versus 7%) and almost twice that of the 65 to 79 group (12%). In propensity‐matched groups, the mortality rate was significantly lower between the ages of 55 and 82 years in patients who underwent surgery compared with patients who did not undergo surgery. Surgery was also associated with better long‐term survival in matched patients who were ≥75 years (hazard ratio, 0.36; 95% CI, 0.24–0.54 [P<0.001]). Conclusions The proportion of elderly patients with infective endocarditis who underwent surgery was low compared with that of younger patients. Surgery was associated with lower mortality irrespective of age. In matched elderly patients, long‐term mortality was higher in patients who did not undergo surgery, suggesting that surgery is underused in elderly patients.
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Affiliation(s)
- Sigurdur Ragnarsson
- Division of Cardiothoracic Surgery Department for Clinical Sciences Lund Lund University and Skane University Hospital Lund Sweden
| | - Sonsoles Salto-Alejandre
- Division of Cardiothoracic Surgery Department for Clinical Sciences Lund Lund University and Skane University Hospital Lund Sweden.,Unit of Infectious Diseases, Microbiology, and Preventive Medicine Institute of Biomedicine of Seville (IBiS) Virgen del Rocío University Hospital/CSIC/University of Seville Seville Spain
| | - Axel Ström
- Clinical Studies Sweden Forum South Lund Sweden
| | - Lars Olaison
- Department of Infectious Diseases Institute of Biomedicine University of Gothenburg Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine Department of Clinical Sciences Lund Lund University and Skane University Hospital Lund Sweden
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Kiriyama H, Kaneko H, Itoh H, Kamon T, Morita K, Jo T, Fujiu K, Daimon M, Takeda N, Morita H, Yasunaga H, Komuro I. Surgical treatment for infective endocarditis in the ageing society: a nationwide retrospective study in Japan. Open Heart 2021; 8:openhrt-2021-001627. [PMID: 33846222 PMCID: PMC8047992 DOI: 10.1136/openhrt-2021-001627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Objective The current status of surgical treatment for infective endocarditis (IE) among very elderly people is unclear. Methods We extracted data on patients in Japan with community-acquired IE who were admitted and discharged between April 2010 and February 2018 using a nationwide inpatient, the Diagnosis Procedure Combination database. We divided patients into three groups: non-elderly (<65 years), elderly (65–79 years) and very elderly (≥80 years). A 1:1 propensity score matching was performed to compare proportions of surgical treatment and in-hospital mortality among the groups. Results We identified 20 667 eligible patients (median age 70 years, 61.0% men). The proportion of very elderly patients significantly increased (19.1% in 2010 to 29.7% in 2018). The proportion of surgical treatment was significantly lower, and in-hospital mortality was significantly higher in very elderly patients. This tendency was more pronounced among patients with in-hospital complications such as heart failure, stroke or embolism. Surgical treatment was significantly associated with lower in-hospital mortality even in very elderly patients, both in an unmatched (OR 0.61; 95% CI 0.47 to 0.78) and a propensity score matched cohort (OR 0.61; 95% CI 0.43 to 0.85). Conclusions The proportion of very elderly patients with IE was increasing, and very elderly patients had higher in-hospital mortality. The proportion of surgical treatment for IE among very elderly patients was low, but it was associated with lower in-hospital mortality. Further studies are needed to establish the optimal strategy for IE among very elderly patients.
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Affiliation(s)
- Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of Advanced Cardiology, The University of Tokyo, Bunkyo-ku, Japan
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo, Bunkyo-ku, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan.,Department of Advanced Cardiology, The University of Tokyo, Bunkyo-ku, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Bunkyo-ku, Japan
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