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Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry
BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. METHODS: Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patie...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10490835/ https://www.ncbi.nlm.nih.gov/pubmed/37682961 http://dx.doi.org/10.1371/journal.pone.0290998 |
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author | Ramos-Martínez, Antonio Domínguez, Fernando Muñoz, Patricia Marín, Mercedes Pedraz, Álvaro Fariñas, Mª Carmen Tascón, Valentín de Alarcón, Arístides Rodríguez-García, Raquel Miró, José María Goikoetxea, Josune Ojeda-Burgos, Guillermo Escrihuela-Vidal, Francesc Calderón-Parra, Jorge |
author_facet | Ramos-Martínez, Antonio Domínguez, Fernando Muñoz, Patricia Marín, Mercedes Pedraz, Álvaro Fariñas, Mª Carmen Tascón, Valentín de Alarcón, Arístides Rodríguez-García, Raquel Miró, José María Goikoetxea, Josune Ojeda-Burgos, Guillermo Escrihuela-Vidal, Francesc Calderón-Parra, Jorge |
author_sort | Ramos-Martínez, Antonio |
collection | PubMed |
description | BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. METHODS: Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. RESULTS: The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62–77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008–2013 and 29.9% in 2014–2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08–1.23), intracardiac abscess (OR:1.78, 95% CI:1.30–2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31–4.19), acute renal failure (OR: 3.11, 95% CI:1.14–2.09), septic shock (OR: 5.56, 95% CI:3.55–8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21–2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49–2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke. CONCLUSIONS: Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable. |
format | Online Article Text |
id | pubmed-10490835 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-104908352023-09-09 Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry Ramos-Martínez, Antonio Domínguez, Fernando Muñoz, Patricia Marín, Mercedes Pedraz, Álvaro Fariñas, Mª Carmen Tascón, Valentín de Alarcón, Arístides Rodríguez-García, Raquel Miró, José María Goikoetxea, Josune Ojeda-Burgos, Guillermo Escrihuela-Vidal, Francesc Calderón-Parra, Jorge PLoS One Research Article BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. METHODS: Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. RESULTS: The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62–77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008–2013 and 29.9% in 2014–2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08–1.23), intracardiac abscess (OR:1.78, 95% CI:1.30–2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31–4.19), acute renal failure (OR: 3.11, 95% CI:1.14–2.09), septic shock (OR: 5.56, 95% CI:3.55–8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21–2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49–2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke. CONCLUSIONS: Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable. Public Library of Science 2023-09-08 /pmc/articles/PMC10490835/ /pubmed/37682961 http://dx.doi.org/10.1371/journal.pone.0290998 Text en © 2023 Ramos-Martínez et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Ramos-Martínez, Antonio Domínguez, Fernando Muñoz, Patricia Marín, Mercedes Pedraz, Álvaro Fariñas, Mª Carmen Tascón, Valentín de Alarcón, Arístides Rodríguez-García, Raquel Miró, José María Goikoetxea, Josune Ojeda-Burgos, Guillermo Escrihuela-Vidal, Francesc Calderón-Parra, Jorge Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry |
title | Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry |
title_full | Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry |
title_fullStr | Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry |
title_full_unstemmed | Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry |
title_short | Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry |
title_sort | clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. lessons learned from a large prospective registry |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10490835/ https://www.ncbi.nlm.nih.gov/pubmed/37682961 http://dx.doi.org/10.1371/journal.pone.0290998 |
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