Clinical Features and Risks Associated with In-hospital Mortality in Patients with Infective Endocarditis at A Medical Center in Central Taiwan from 2012 to 2016 - A Retrospective Analysis

感染性心內膜炎的臨床特徵與影響住院死亡率的因素－一家中台灣醫學中心從2012年到2016年的回溯性分析

林玉佳(Yu-Chia Lin) ； 鄭傑夫(Jie-Fu Zheng) ； 林育蕙(Yu-Hui Lin)

《內科學誌》 29卷5期 (2018/10) Pp. 309-316

https://doi.org/10.6314/JIMT.201810_29(5).05

摘要

To outline the clinical features and identify risks associated with in-hospital mortality in patients with infective endocarditis. Adult patients who were diagnosed with definite infective endocarditis (IE) from January 2012 to December 2016 were retrospectively analyzed. A total of 87 patients, including 57 (65.5%) men and 30 (34.5%) women, were included, with a mean age of 54.1±16.6 years (ranging from 18 to 85 years). Fifty (57.5%) patients had mitral valves involvement. Among the 87 patients, 32 (36.8%) had IE by Staphylococcus aureus, while 14 (16.1%) patients had IE by methicillin-resistant Staphylococcus aureus (MRSA). Liver cirrhosis (Odd Ratio [OR] 18.38, 95% Confidence Interval (CI) 2.46-137.20, p=0.007) and diabetes mellitus (OR 4.52, 95% CI 1.01-20.30, p=0.049) were both associated with IE by MRSA. Twenty of the 87 patients died during the hospitalization, with the in-hospital mortality rate being 23.0%. The age older than 65 years was associated with an increased in-hospital mortality rate (OR 5.81, 95% CI 1.62-20.87, p=0.007). Infective endocarditis remains a lethal disease, particularly in the elderly. Clinicians should not underestimate the prevalence of MRSA infection in patients with infective endocarditis.

關鍵字

Mortality ； Methicillin-resistant ； Infective endocarditis

並列摘要

本研究目的在於分析感染性心內膜炎患者的臨床特徵並探討影響住院死亡率的因素。本研究針對2012年1月至2016年12月的成人感染性心內膜炎患者進行回溯性分析。在87位納入研究對象的患者當中，57位(65.5%)為男性，30位(34.5%)為女性，平均年齡為54.1±16.6歲(範圍從18歲到85歲)。87位研究對象中有50位(57.5%)患者的二尖瓣受影響。32位(36.8%)患者有金黃色葡萄球菌菌血症，而14位(16.1%)患者有耐甲氧西林金黃色葡萄球菌菌血症。肝硬化(OR 18.38, 95% CI 2.46-137.20, p=0.007)與糖尿病(OR 4.52, 95% CI 1.01-20.30, p=0.049)與耐甲氧西林金黃色葡萄球菌菌血症有關。整體住院死亡率為23.0%。年齡大於65歲與較高的住院死亡率有關(OR of 5.81, 95% CI 1.62-20.87, p=0.007)。本研究發現感染性心內膜炎仍屬於致命性的疾病，尤其在老年人更是如此。臨床醫師勿低估耐甲氧西林金黃色葡萄球菌感染在感染性心內膜炎的盛行率。