Juan M Pericàs1, Marta Hernández-Meneses1, Patricia Muñoz2, Manuel Martínez-Sellés3, Ana Á Lvarez-Uria2, Arístides de Alarcón4, Encarnación Gutiérrez-Carretero5, Miguel A Goenaga6, Manuel J Zarauza7, Carlos Falces8, M Ángeles Rodríguez-Esteban9, Carmen Hidalgo-Tenorio10, Michele Hernández-Cabrera11, Jose M Miró1. 1. Infectious Diseases Service. Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain. 2. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Sanitaria Gregorio Marañón. CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058). Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. 3. Cardiology Department. Hospital Universitario Gregorio Marañón. CIBERCV. Universidad Europea. Universidad Complutense. Madrid, Spain. 4. Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Infectious Diseases Research Group.Institute of Biomedicine of Seville (IBiS). University Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain. 5. Cardiac Surgery Service. CIBERCV. Institute of Biomedicine of Seville (IBiS). University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain. 6. Servicio de Enfermedades Infecciosas. Hospital Universitario Donosti. ISS Biodonostia, San Sebastián, Spain. 7. Servicio de Cardiología. Hospital Universitario Marqués de Valdecilla, Santander, Spain. 8. Cardiology Service. Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain. 9. Servicio de UCI Cirugía Cardiaca. Hospital Central de Asturias, Oviedo, Spain. 10. Unidad de Enfermedades Infecciosas. Hospital Universitario Virgen de las Nieves, Granada, Spain. 11. Unidad de Enfermedades Infecciosas y Medicina Tropical Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain.
Abstract
BACKGROUND: Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking. We aimed to investigate the characteristics and outcomes of endocarditis patients presenting with acute heart failure (AHF), particularly of those developing CS. METHODS: Prospectively collected cohort from 35 Spanish centers (2008-2018). Logistic regression analyses were performed to identify risk factors for developing CS and predictors of mortality. RESULTS: Amongst 4,856 endocarditis patients, 1,652 (34%) had AHF and 244 (5%) CS. Compared to patients without AHF and AHF but no CS, patients with CS presented higher rates of surgery (40.5%, 52.5% and 68%,p<.001) and in-hospital mortality (16.3%,39.1%, and 52.5%). Compared to patients with septic shock, CS patients presented higher rates of surgery (42.5% vs. 68%, p<.001), and lower rates of in-hospital and 1-year mortality (62.3% vs. 52.5%,p.008;and 65.3% vs. 57.4%,p.030). Severe aortic and mitral regurgitation (OR 2.47, 95%CI 1.82-3.35 and OR 3.03, 95%CI 2.26-4.07, both p<.001), left-ventricle ejection fraction<60% (OR 1.72, 95%CI 1.22-2.40, p.002), heart block (OR 2.22, 95%CI 1.41-3.47, p.001), tachyarrhythmias (OR 5.07,95%CI 3.13-8.19, p<.001) and acute kidney failure (OR 2.29, 95%CI 1.73-3.03,p<.001) were associated to a higher likelihood of developing CS. Prosthetic endocarditis (OR 2.03, 95%CI 1.06-3.88, p.032), S. aureus (OR 3.10, 95%CI 1.16-8.30, p.024), tachyarrhythmias (OR 3.09,95%CI 1.50-10.13, p.005), and not performing cardiac surgery (OR 11.40, 95%CI 4.83-26.90, p<.001) were associated to a higher risk of mortality. CONCLUSIONS: Acute heart failure is common among patients with endocarditis. Cardiogenic shock is associated to very high mortality and should be promptly identified and assessed for cardiac surgery.
BACKGROUND: Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking. We aimed to investigate the characteristics and outcomes of endocarditispatients presenting with acute heart failure (AHF), particularly of those developing CS. METHODS: Prospectively collected cohort from 35 Spanish centers (2008-2018). Logistic regression analyses were performed to identify risk factors for developing CS and predictors of mortality. RESULTS: Amongst 4,856 endocarditispatients, 1,652 (34%) had AHF and 244 (5%) CS. Compared to patients without AHF and AHF but no CS, patients with CS presented higher rates of surgery (40.5%, 52.5% and 68%,p<.001) and in-hospital mortality (16.3%,39.1%, and 52.5%). Compared to patients with septic shock, CSpatients presented higher rates of surgery (42.5% vs. 68%, p<.001), and lower rates of in-hospital and 1-year mortality (62.3% vs. 52.5%,p.008;and 65.3% vs. 57.4%,p.030). Severe aortic and mitral regurgitation (OR 2.47, 95%CI 1.82-3.35 and OR 3.03, 95%CI 2.26-4.07, both p<.001), left-ventricle ejection fraction<60% (OR 1.72, 95%CI 1.22-2.40, p.002), heart block (OR 2.22, 95%CI 1.41-3.47, p.001), tachyarrhythmias (OR 5.07,95%CI 3.13-8.19, p<.001) and acute kidney failure (OR 2.29, 95%CI 1.73-3.03,p<.001) were associated to a higher likelihood of developing CS. Prosthetic endocarditis (OR 2.03, 95%CI 1.06-3.88, p.032), S. aureus (OR 3.10, 95%CI 1.16-8.30, p.024), tachyarrhythmias (OR 3.09,95%CI 1.50-10.13, p.005), and not performing cardiac surgery (OR 11.40, 95%CI 4.83-26.90, p<.001) were associated to a higher risk of mortality. CONCLUSIONS:Acute heart failure is common among patients with endocarditis. Cardiogenic shock is associated to very high mortality and should be promptly identified and assessed for cardiac surgery.
Authors: Joop J P Kouijzer; Daniëlle J Noordermeer; Wouter J van Leeuwen; Nelianne J Verkaik; Kirby R Lattwein Journal: Front Cell Dev Biol Date: 2022-10-03