J Ruiz-Morales1, R Ivanova-Georgieva2, N Fernández-Hidalgo3, E García-Cabrera4, Jose M Miró5, P Muñoz6, B Almirante7, A Plata-Ciézar8, V González-Ramallo9, J Gálvez-Acebal10, M C Fariñas11, J M Bravo-Ferrer12, M A Goenaga-Sánchez13, C Hidalgo-Tenorio14, J Goikoetxea-Agirre15, A de Alarcón-González16. 1. UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. Electronic address: mjruizm@gmail.com. 2. Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. Electronic address: drradabg@yahoo.com. 3. Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: nufernan@gmail.com. 4. UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Electronic address: emiliogcabrera@gmail.com. 5. Hospital Clinic - IDIBAPS, Servicio de Enfermedades Infecciosas y Microbiología, Universidad de Barcelona, Barcelona, Spain. Electronic address: jmmiro@ub.edu. 6. Servicio de Microbiología y Enfermedades infecciosas, H. Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: pmunoz@micro.hggm.es. 7. Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: benitoalmirante@gmail.com. 8. UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital General Universitario, Málaga, Spain. Electronic address: nonispc@hotmail.com. 9. Unidad de Hospitalización a Domicilio, H. Universitario Gregorio Marañón, Madrid, Spain. Electronic address: vgramallo@orange.es. 10. UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain. Electronic address: jga@us.es. 11. Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain. Electronic address: mcfarinas@humv.es. 12. Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain. Electronic address: josem.bravoferrer.acosta@hotmail.com. 13. Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain. Electronic address: goenagasanchez@gmail.com. 14. Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain. Electronic address: chidalgo72@gmail.com. 15. Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain. Electronic address: anejosune.goikoetxeaagirre@osakidetza.net. 16. UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Electronic address: aa2406ge@yahoo.es.
Abstract
OBJECTIVE: To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS: Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS: A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS: Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
OBJECTIVE: To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS: Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS: A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS:Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
Authors: F Gouriet; H Chaudet; P Gautret; L Pellegrin; V P de Santi; H Savini; G Texier; D Raoult; P-E Fournier Journal: New Microbes New Infect Date: 2018-05-30
Authors: José A Parra; Luis Hernández; Patricia Muñoz; Gerardo Blanco; Regino Rodríguez-Álvarez; Daniel Romeu Vilar; Arístides de Alarcón; Miguel Angel Goenaga; Mar Moreno; María Carmen Fariñas Journal: Medicine (Baltimore) Date: 2018-08 Impact factor: 1.889