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- Title
Characteristics and Outcome of Acute Heart Failure in Infective Endocarditis: Focus on Cardiogenic Shock.
- Authors
Pericàs, Juan M; Hernández-Meneses, Marta; Muñoz, Patricia; Martínez-Sellés, Manuel; Álvarez-Uria, Ana; Alarcón, Arístides de; Gutiérrez-Carretero, Encarnación; Goenaga, Miguel A; Zarauza, Manuel J; Falces, Carlos; Rodríguez-Esteban, M Ángeles; Hidalgo-Tenorio, Carmen; Hernández-Cabrera, Michele; Miró, Jose M; (GAMES), Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España
- Abstract
Background Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking. 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 Among 4856 endocarditis patients, 1652 (34%) had acute heart failure (AHF) and 244 (5%) CS. Compared with 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 with 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 [95% CI], 2.47 [1.82-3.35] and 3.03 [2.26-4.07]; both P <.001), left-ventricle ejection fraction <60% (1.72; 1.22-2.40; P =.002), heart block (2.22; 1.41-3.47; P =.001), tachyarrhythmias (5.07; 3.13-8.19; P <.001), and acute kidney failure (2.29; 1.73-3.03; P <.001) were associated with higher likelihood of developing CS. Prosthetic endocarditis (2.03; 1.06 -3.88; P =.032), Staphylococcus aureus (3.10; 1.16 -8.30; P =.024), tachyarrhythmias (3.09; 1.50-10.13; P =.005), and not performing cardiac surgery (11.40; 4.83-26.90; P <.001) were associated with a higher risk of mortality. Conclusions AHF is common among patients with endocarditis. CS is associated with high mortality and should be promptly identified and assessed for cardiac surgery.
- Subjects
SPAIN; MORTALITY risk factors; EVALUATION of medical care; MITRAL valve insufficiency; CONFIDENCE intervals; VENTRICULAR ejection fraction; TIME; INDEPENDENT variables; INFECTIVE endocarditis; COMPARATIVE studies; HEART block; SYMPTOMS; CARDIOGENIC shock; DESCRIPTIVE statistics; TACHYCARDIA; PROSTHETIC heart valves; STAPHYLOCOCCUS aureus; LOGISTIC regression analysis; AORTIC valve insufficiency; ODDS ratio; HEART failure; LONGITUDINAL method; PROBABILITY theory; ACUTE kidney failure; DISEASE risk factors; DISEASE complications; EVALUATION
- Publication
Clinical Infectious Diseases, 2021, Vol 73, Issue 5, p765
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab098