Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery
Aims Surgery in patients with infective endocarditis (IE) can be elective (upon completion of antibiotic treatment) or urgent (before antibiotic treatment has ended) when the clinical course is unfavourable. However, urgent surgery for left-sided endocarditis is associated with high mortality. The a...
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| Veröffentlicht in: | European heart journal 2007-01, Vol.28 (1), p.65-71 |
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| creator | Revilla, Ana López, Javier Vilacosta, Isidre Villacorta, Eduardo Rollán, María J. Echevarría, José R. Carrascal, Yolanda Di Stefano, Salvatore Fulquet, Enrique Rodríguez, Enrique Fiz, Luis San Román, José A. |
| description | Aims Surgery in patients with infective endocarditis (IE) can be elective (upon completion of antibiotic treatment) or urgent (before antibiotic treatment has ended) when the clinical course is unfavourable. However, urgent surgery for left-sided endocarditis is associated with high mortality. The aims of this study were to describe the profile of patients with left-sided endocarditis who underwent urgent surgery and to analyse the factors that predicted mortality.
Methods and results Among 508 consecutive episodes of IE, 391 were left-sided and 89 required urgent surgery. The main reasons for urgent surgery were heart failure that did not respond to medication (72%) and persistent infection despite appropriate antibiotic treatment (31%). Thirty-two patients (36%) died during their hospital stay. Univariate analysis identified renal failure, septic shock, Gram-negative bacteria, persistent infection, and surgery for persistent infection as factors associated with mortality. Multivariate analysis confirmed only persistent infection and renal insufficiency as factors independently associated with a poor prognosis.
Conclusion Patients with IE who need urgent surgery have a poor clinical course. Heart failure, the main cause of urgent surgery, was not associated with higher mortality. However, persistent infection and renal failure were factors associated with higher post-surgical mortality. |
| doi_str_mv | 10.1093/eurheartj/ehl315 |
| format | Article |
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Methods and results Among 508 consecutive episodes of IE, 391 were left-sided and 89 required urgent surgery. The main reasons for urgent surgery were heart failure that did not respond to medication (72%) and persistent infection despite appropriate antibiotic treatment (31%). Thirty-two patients (36%) died during their hospital stay. Univariate analysis identified renal failure, septic shock, Gram-negative bacteria, persistent infection, and surgery for persistent infection as factors associated with mortality. Multivariate analysis confirmed only persistent infection and renal insufficiency as factors independently associated with a poor prognosis.
Conclusion Patients with IE who need urgent surgery have a poor clinical course. Heart failure, the main cause of urgent surgery, was not associated with higher mortality. However, persistent infection and renal failure were factors associated with higher post-surgical mortality.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehl315</identifier><identifier>PMID: 17032690</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Anti-Bacterial Agents - therapeutic use ; Biological and medical sciences ; Cardiology. Vascular system ; Echocardiography, Transesophageal ; Emergency Treatment ; Endocardial and cardiac valvular diseases ; Endocarditis, Bacterial - drug therapy ; Endocarditis, Bacterial - mortality ; Endocarditis, Bacterial - surgery ; Heart ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Hospital Mortality ; Humans ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Prognosis ; Prospective Studies ; Renal failure</subject><ispartof>European heart journal, 2007-01, Vol.28 (1), p.65-71</ispartof><rights>The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org 2007</rights><rights>2007 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Jan 2007</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3785-786900901c4263f5bce8a120339e2d45397f27cf1cea2069e760299fad03ec673</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18461374$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17032690$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Revilla, Ana</creatorcontrib><creatorcontrib>López, Javier</creatorcontrib><creatorcontrib>Vilacosta, Isidre</creatorcontrib><creatorcontrib>Villacorta, Eduardo</creatorcontrib><creatorcontrib>Rollán, María J.</creatorcontrib><creatorcontrib>Echevarría, José R.</creatorcontrib><creatorcontrib>Carrascal, Yolanda</creatorcontrib><creatorcontrib>Di Stefano, Salvatore</creatorcontrib><creatorcontrib>Fulquet, Enrique</creatorcontrib><creatorcontrib>Rodríguez, Enrique</creatorcontrib><creatorcontrib>Fiz, Luis</creatorcontrib><creatorcontrib>San Román, José A.</creatorcontrib><title>Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims Surgery in patients with infective endocarditis (IE) can be elective (upon completion of antibiotic treatment) or urgent (before antibiotic treatment has ended) when the clinical course is unfavourable. However, urgent surgery for left-sided endocarditis is associated with high mortality. The aims of this study were to describe the profile of patients with left-sided endocarditis who underwent urgent surgery and to analyse the factors that predicted mortality.
Methods and results Among 508 consecutive episodes of IE, 391 were left-sided and 89 required urgent surgery. The main reasons for urgent surgery were heart failure that did not respond to medication (72%) and persistent infection despite appropriate antibiotic treatment (31%). Thirty-two patients (36%) died during their hospital stay. Univariate analysis identified renal failure, septic shock, Gram-negative bacteria, persistent infection, and surgery for persistent infection as factors associated with mortality. Multivariate analysis confirmed only persistent infection and renal insufficiency as factors independently associated with a poor prognosis.
Conclusion Patients with IE who need urgent surgery have a poor clinical course. Heart failure, the main cause of urgent surgery, was not associated with higher mortality. However, persistent infection and renal failure were factors associated with higher post-surgical mortality.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Echocardiography, Transesophageal</subject><subject>Emergency Treatment</subject><subject>Endocardial and cardiac valvular diseases</subject><subject>Endocarditis, Bacterial - drug therapy</subject><subject>Endocarditis, Bacterial - mortality</subject><subject>Endocarditis, Bacterial - surgery</subject><subject>Heart</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Renal failure</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctrGzEQh0VIaNyk956KCLSXso0eq9cxmL4gkEsKuQlFO4pl1pIr7Tbkv4-MTQK95DSC-WbmJz6EPlLyjRLDL2EuK3BlWl_CauRUHKEFFYx1RvbiGC0INaKTUt-dove1rgkhWlL5Dp1SRTiThiyQXY4xRe9G7NKAtyU_pFyn6HfPEEfAOeCtmyKkqeLHOK1wTAH8FP8BhjRk78oQp9h6q4wTwIDn8tBgXHe1PJ2jk-DGCh8O9Qz9-fH9dvmru775-Xt5dd15rrTolG5piCHU90zyIO49aEcZ4dwAG3rBjQpM-UA9OEakASUJMya4gXDwUvEz9GW_t-X-O0Od7CZWD-PoEuS5Wql7JgTVb4LUKNNL3jfw4j9wneeS2icso0IQzZRpENlDvuRaCwS7LXHjypOlxO4U2RdFdq-ojXw67J3vNzC8DhycNODzAXC1iQnFJR_rK6d7SbnaBfy65_K8ffvsMw7Bq_g</recordid><startdate>200701</startdate><enddate>200701</enddate><creator>Revilla, Ana</creator><creator>López, Javier</creator><creator>Vilacosta, Isidre</creator><creator>Villacorta, Eduardo</creator><creator>Rollán, María J.</creator><creator>Echevarría, José R.</creator><creator>Carrascal, Yolanda</creator><creator>Di Stefano, Salvatore</creator><creator>Fulquet, Enrique</creator><creator>Rodríguez, Enrique</creator><creator>Fiz, Luis</creator><creator>San Román, José A.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>200701</creationdate><title>Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery</title><author>Revilla, Ana ; López, Javier ; Vilacosta, Isidre ; Villacorta, Eduardo ; Rollán, María J. ; Echevarría, José R. ; Carrascal, Yolanda ; Di Stefano, Salvatore ; Fulquet, Enrique ; Rodríguez, Enrique ; Fiz, Luis ; San Román, José A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3785-786900901c4263f5bce8a120339e2d45397f27cf1cea2069e760299fad03ec673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Echocardiography, Transesophageal</topic><topic>Emergency Treatment</topic><topic>Endocardial and cardiac valvular diseases</topic><topic>Endocarditis, Bacterial - drug therapy</topic><topic>Endocarditis, Bacterial - mortality</topic><topic>Endocarditis, Bacterial - surgery</topic><topic>Heart</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Renal failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Revilla, Ana</creatorcontrib><creatorcontrib>López, Javier</creatorcontrib><creatorcontrib>Vilacosta, Isidre</creatorcontrib><creatorcontrib>Villacorta, Eduardo</creatorcontrib><creatorcontrib>Rollán, María J.</creatorcontrib><creatorcontrib>Echevarría, José R.</creatorcontrib><creatorcontrib>Carrascal, Yolanda</creatorcontrib><creatorcontrib>Di Stefano, Salvatore</creatorcontrib><creatorcontrib>Fulquet, Enrique</creatorcontrib><creatorcontrib>Rodríguez, Enrique</creatorcontrib><creatorcontrib>Fiz, Luis</creatorcontrib><creatorcontrib>San Román, José A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Revilla, Ana</au><au>López, Javier</au><au>Vilacosta, Isidre</au><au>Villacorta, Eduardo</au><au>Rollán, María J.</au><au>Echevarría, José R.</au><au>Carrascal, Yolanda</au><au>Di Stefano, Salvatore</au><au>Fulquet, Enrique</au><au>Rodríguez, Enrique</au><au>Fiz, Luis</au><au>San Román, José A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2007-01</date><risdate>2007</risdate><volume>28</volume><issue>1</issue><spage>65</spage><epage>71</epage><pages>65-71</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims Surgery in patients with infective endocarditis (IE) can be elective (upon completion of antibiotic treatment) or urgent (before antibiotic treatment has ended) when the clinical course is unfavourable. However, urgent surgery for left-sided endocarditis is associated with high mortality. The aims of this study were to describe the profile of patients with left-sided endocarditis who underwent urgent surgery and to analyse the factors that predicted mortality.
Methods and results Among 508 consecutive episodes of IE, 391 were left-sided and 89 required urgent surgery. The main reasons for urgent surgery were heart failure that did not respond to medication (72%) and persistent infection despite appropriate antibiotic treatment (31%). Thirty-two patients (36%) died during their hospital stay. Univariate analysis identified renal failure, septic shock, Gram-negative bacteria, persistent infection, and surgery for persistent infection as factors associated with mortality. Multivariate analysis confirmed only persistent infection and renal insufficiency as factors independently associated with a poor prognosis.
Conclusion Patients with IE who need urgent surgery have a poor clinical course. Heart failure, the main cause of urgent surgery, was not associated with higher mortality. However, persistent infection and renal failure were factors associated with higher post-surgical mortality.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>17032690</pmid><doi>10.1093/eurheartj/ehl315</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals |
| subjects | Anti-Bacterial Agents - therapeutic use Biological and medical sciences Cardiology. Vascular system Echocardiography, Transesophageal Emergency Treatment Endocardial and cardiac valvular diseases Endocarditis, Bacterial - drug therapy Endocarditis, Bacterial - mortality Endocarditis, Bacterial - surgery Heart Heart failure, cardiogenic pulmonary edema, cardiac enlargement Hospital Mortality Humans Medical sciences Middle Aged Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Prognosis Prospective Studies Renal failure |
| title | Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery |
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