Hacettepe Üniversitesi Hastanelerinde 2000-2013 Yılları Arasında Infektif Endokardit Tanısı ile Yatarak Izlenmiş Olan Erişkin Hastaların Klinik Özelliklerinin Retrospektif Olarak Incelenmesi

Abstract

Aim: This study aims to evaluate clinical, laboratory, microbiological, and echocardiographic characteristics of patients with infective endocarditis (IE) at our hospital which is a tertiary care center and to identify predictors of inhospital mortality. In particular, this study was designed to evaluate the relationship between survival and surgical treatment or the medications along with the risk factors brought by patients, in order to contribute to the subsequent management process of IE patients. Methods: Based on a systematic retrospective review of clinical records covering 2000 to 2013, we analyzed and compared data and outcomes of 122 patients (77 males, 45 females; mean age 52,5 ± 14,2 years) with definite or possible IE according to the modified Duke criteria. The difference between the groups were accepted to be significant if p<0.05. Results: The classification of patients according to the site of infection or the precence of intracardiac device is as follows: 69 (56,6%) left sided native valve IE, 38 (31,2%) left sided prosthetic valve IE (9 early, 29 late prosthetic valve endocarditis), 5 (4,1%) right sided IE, 5 (4,1%) intracardiac device associated IE and 5 (%4,1) IE which the site of vegetation is not defined. The mean age of patients with IE, is increasing in parallel to the European countries and older age was associated with death (OR: 1,037, p = 0,026). History of acute rheumatic fever has been identified as the most common heart-related predisposing factor (35%) and incidence is much higher than in developed countries. S. aureus was determined to be the most frequently isolated vii microorganism (25,5%) in both natural and prosthetic valves and no significant relationship with mortality has been detected. The ratio of culture-negative endocarditis was 33,3%, which is quite higher than the specified limit (<5%). In our series, the in-hospital mortality rate was determined at a rate as high as 26,2%. Surgical treatment ratio was 29,5%; among patients who have been operated, in-hospital mortality rate was found to be 22%. Among the complications during the clinical follow-up; acute kidney injury, liver function test abnormalities, neurological symptoms, pneumonia, mechanical ventilation, hypotension, sepsis, worsening of control echocardiography, newly developing heart failure, DIC (disseminated intravascular coagulation) and bleeding was found to be significantly associated with death. Variables that can predict mortality on the time of admission were age, presence of hypertension, diabetes mellitus, acute duration of symptoms (less than 15 days), acetylsalicylate use, use of antiplatelet agents other than acetylsalicylate, high C-reactive protein, high serum creatinine levels and increased pulmonary arterial pressure. Conclusion: This study shows that there have been remarkable changes in the epidemiology of IE in our country. Logistic analysis show that variables that determine the risk of death at the highest rate are worsening of the control echocardiography (OR: 5,437, p=0.026) and antiplatelet use (acetylsalicylate (OR: 2,644, p=0,021) antiplatelets other than acetylsalicylate (OR: 3,952, p=0,015) ) respectively.