Ulus Travma Acil Cerrahi Derg. 2023; 29(9): 996-1003 | DOI: 10.14744/tjtes.2023.23162

In-hospital outcomes of patients undergoing emergent surgical treatment in patients with infective endocarditis

Ali Kemal Kalkan¹, Serkan Kahraman¹, Gökhan Demirci¹, Hicaz Zencirkiran Agus¹, Ender Oner¹, Kübra Kalkan², Mustafa Yildiz^1
1Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul-Türkiye
²Department of Rheumatology, University of Health Sciences, Basaksehir Cam ve Sakura City Hospital, Ýstanbul-Türkiye

BACKGROUND: Infective endocarditis is a serious heart disease that may cause several different clinical conditions and can need urgent surgical therapy. In our study, we aimed to evaluate the patients with infective endocarditis undergoing acute surgical treatment results in-hospital mortality.
METHODS: A total of 107 consecutive patients with infective endocarditis undergoing acute surgical therapy were included in our retrospective study. The patients were divided into two groups according to the presence of in-hospital mortality as Group 1 without in-hospital mortality (n=89) and Group 2 with in-hospital mortality (n=18). The demographic, laboratory, and clinical parameters were evaluated in both groups.
RESULTS: The mean age (50±14; 64±14, P<0.001) and the incidence of chronic renal failure (9 [10.1%]; 8 [44.4%], P=0.001) were higher in Group 2 while the ejection fraction was lower in Group 2 (50.0±9.3; 44.6±12.9, P=0.039). The incidence of positive blood culture was also higher in Group 2 (41 [46.1]; 14 [77.8], P=0.014). Aortic bioprosthesis operation (2 [2.2]; 6 [33.3], P<0.001) and mitral bioprosthesis operation (4 [4.5]; 5 [27.8], P=0.008) were higher in Group 2 as well as the incidence of septic shock was also higher in Group 2 (1 [1.1]; 3 [16.7], P=0.015). In addition, in multivariate logistic regression analyses, advanced age (odds ratio [OR]: 1.068, 95% confidence interval [CI]: 1.009–1.130, P: 0.024) and positive blood culture (OR: 4.436, 95% CI: 1.044–18.848, P: 0.044) were found to be independent predictors of in-hospital mortality.
CONCLUSION: Advanced age, lower ejection fraction, high creatinine, positive blood culture, high systolic pulmonary artery pressure, and septic shock predicted in-hospital death in patients who have undergone emergent or urgent surgery due to infective endocarditis.

Keywords: Emergent surgery, infective endocarditis; in-hospital mortality.

---

Acil cerrahi tedavi uygulanan enfektif endokardit hastalarýnýn hastane içi sonlanýmlarý

Ali Kemal Kalkan¹, Serkan Kahraman¹, Gökhan Demirci¹, Hicaz Zencirkiran Agus¹, Ender Oner¹, Kübra Kalkan², Mustafa Yildiz^1
1Saðlýk Bilimleri Üniversitesi, Mehmet Akif Ersoy Göðüs Kalp ve Damar Cerrahisi Eðitim ve Araþtýrma Hastanesi, Kardiyoloji Bölümü, Ýstanbul, Türkiye
²Saðlýk Bilimleri Üniversitesi, Baþaksehir Cam ve Sakura Þehir Hastanesi, Romatoloji Bölümü, Ýstanbul, Türkiye

AMAÇ: Enfektif endokardit birkaç farklý klinik duruma neden olabilen ve acil cerrahi tedavi gerektirebilen ciddi bir kalp hastalýðýdýr. Çalýþmamýzda akut cerrahi tedavi uygulanan enfektif endokarditli hastalarýn hastane içi mortalite sonuçlarýný deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Retrospektif çalýþmamýza akut cerrahi tedavi uygulanan enfektif endokarditli ardýþýk toplam 107 hasta dahil edildi. Hastalar hastane içi mortalite varlýðýna göre hastane içi mortalite olmayan grup 1 (n=89) ve hastane içi mortalite olan grup 2 (n=18) olarak iki gruba ayrýldý. Her iki grupta demografik, laboratuvar ve klinik parametreler deðerlendirildi.
BULGULAR: Ortalama yaþ (50±14; 64±14, p<0.001) ve kronik böbrek yetmezliði insidansý [9 (%10.1); 8 (%44,4), p=0.001] grup 2'de daha yüksek, ejeksiyon fraksiyonu ise grup 2'de daha düþüktü [50.0±9.3; 44.6±12.9, p=0.039]. Pozitif kan kültürü insidansý da grup 2'de daha yüksekti [41 (46.1); 14 (77.8), p=0.014]. Aortik biyoprotez ameliyatý [2 (2.2); 6 (33.3), p<0.001] ve mitral biyoprotez ameliyatý [4 (4.5); 5 (27.8), p=0.008] grup 2'de daha yüksekti ve septik þok insidansý da grup 2'de daha yüksekti [1 (1.1); 3 (16.7), p=0.015]. Ayrýca çok deðiþkenli lojistik regresyon analizlerinde ileri yaþ [Odds oraný: 1.068, %95CI: 1.009-1.130, p=0.024] ve pozitif kan kültürünün [Odds oraný: 4.436, %95CI: 1.044-18.848, p=0.044] hastane içi mortalitenin baðýmsýz belirteçleri olduðu bulundu.
SONUÇ: Ýleri yaþ, düþük ejeksiyon fraksiyonu, yüksek kreatinin, pozitif kan kültürü, yüksek sistolik pulmoner arter basýncý, septik þok enfektif en-dokardit nedeniyle acil cerrahi uygulanan hastalarda hastane içi ölümü öngördürücüsü olarak belirlendi.

Anahtar Kelimeler: Cerrahi, hastane içi mortalite; infektif endokardit.

---

CITE