| Background:Infective endocarditis(IE)is an infective disease involving endocardium.Despite advances in diagnosis and treatment,mortality is still high.Therefore,analysing risk at the early diagnosis stage and determining appropriate treatment options are keys to increasing survival time and improving long-term prognosis.In addition to antimicrobial treatment,international guidelines present a positive effect of early surgery.It’s also recommended that surgery should be delayed if patient with stroke,but conclusion remains controversial.Will delayed surgery reduce operation risk be more benefit againstlonger survival time result in early surgery,question need more clinical data to proove.Objective:At present,researches about IE are mostly lauched by developed countries.However,epidemiology and medical situation differs from country to country,makes the international guideline face the challenge in practical application.It is necessary for domestic analysis to prove the practical application of the guideline.Material and Methods;The study launched a retrospective research of in-hospital IE patients from 2014.1.1 to 2017.12.31 in Peking Union Medical College Hospital(PUMCH).All patients diagnosed IE with revised DUKE criteria.A unified table has been designed to collect clinical data,including basic conditions,clinical symptoms and signs,pathogenic evidence,evidence of endocardial involvement,laboratory examination,imaging test,preoperative complications,susceptibility factors,antimicrobial treatment and surgury.Death is the end point of observation.The influencing factors of prognosis are analyzed with different sampling standards and grouping methods.Results:The study included 232 total clinical data,with a follow-up rate of 87.5%(29 missed).Average age of follow-up sample is 47.6±15.4.143 patients underwent surgery,of which 28 diagnosed ischemic stroke,14 diagnosed hemorrhagic stroke.Analysis about 203 IE patients,survival time analysis shows that age,consciousness,muscle strength impairment,preoperation cerebral hemorrhage are independent risk factors for death(P value<0.05,RR>1),while surgery can protect patients against death(P value=0.026,RR=0.266).Analysis on surgery patients shows,early surgery has no significant effect on expected survival time(P value=0.916).Early surgery helps shorten antimicrobial treatment course(P value=O.008).Multiple factor COX regression model showed that age,hemiplegia,abnominal sign of nerve system are independent risk factors for death(P value<0.10,RR>1).And age,severe cardiac structure abnormality,post medical history of rheumatic heart disease,surum creatinine and cTnI elevation,delay of surgery show negative effect on postoperation duration(P value<0.10,RR>1).For patients with ischemic stroke,early suegery gourp showed a tendency towards less nervous symptoms remained(P value=0.042),and showes no significant difference on survival time or post-operative nervous complication(P value>0.05).Timing of surgery for patients with hemorrhagic stroke shows no relation with prognosis in this research(P>0.05).Conclusions:1、Composision of this research is quite different from data of developed country,and the mortality rate is low.2、Surgery reduces the risk of death.Age,consciousness,muscle strength impairment,preoperative cerebral hemorrhage and negative blood culture are independent risk factors for poor prognosis.3、Early surgery does not reduce the mortality rate,but shortens the anti-microorganism course and does not increase recurrence rate.4、Age,severe cardiac structural changes,PMH of rheumatic heart disease,increased serum cTnI and creatine levels related to perioperative risk.5、Early surgery for patients with cerebral infarction reduces the residual CNS symptoms and does not increase mortality rate.Early surgery for patients with cerebral hemorrhage showes no statistic relation with perioperative risk or long-term prognosis. |
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