Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?
Abstract
:1. Introduction
2. Patients and Methods
3. Results
Baseline, Risk Profile, and Comorbidities
4. Preoperative Diagnosis and Condition
5. Postoperative Course and Complications
6. Discussion
7. Limitations
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ostovar, R.; Schroeter, F.; Erb, M.; Kuehnel, R.U.; Hartrumpf, M.; Albes, J.M. Endocarditis: Who Is Particularly at Risk and Why? Ten Years Analysis of Risk Factors for In-hospital Mortality in Infective Endocarditis. Thorac. Cardiovasc. Surg. 2022, 71, 12–21. [Google Scholar] [CrossRef] [PubMed]
- Bin Abdulhak, A.A.; Baddour, L.M.; Erwin, P.J.; Hoen, B.; Chu, V.H.; Mensah, G.A.; Tleyjeh, I.M. Global and Regional Burden of Infective Endocarditis, 1990–2010: A Systematic Review of the Literature. Glob. Heart 2014, 9, 131–143. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ostovar, R.; Schroeter, F.; Kuehnel, R.U.; Erb, M.; Filip, T.; Claus, T.; Albes, J.M. Endocarditis: An Ever Increasing Problem in Cardiac Surgery. Thorac. Cardiovasc. Surg. 2019, 67, 616–623. [Google Scholar] [CrossRef] [PubMed]
- Ursi, M.P.; Durante Mangoni, E.; Rajani, R.; Hancock, J.; Chambers, J.B.; Prendergast, B. Infective Endocarditis in the Elderly: Diagnostic and Treatment Options. Drugs Aging 2019, 36, 115–124. [Google Scholar] [CrossRef] [PubMed]
- Selton-Suty, C.; Célard, M.; Le Moing, V.; Doco-Lecompte, T.; Chirouze, C.; Iung, B.; Strady, C.; Revest, M.; Vandenesch, F.; Bouvet, A.; et al. Preeminence of Staphylococcus aureus in infective endocarditis: A 1-year population-based survey. Clin. Infect. Dis. 2012, 54, 1230–1239. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Slipczuk, L.; Codolosa, J.N.; Davila, C.D.; Romero-Corral, A.; Yun, J.; Pressman, G.S.; Figueredo, V.M. Infective endocarditis epidemiology over five decades: A systematic review. PLoS ONE 2013, 8, e82665. [Google Scholar] [CrossRef] [PubMed]
- Bea, C.; Vela, S.; García-Blas, S.; Perez-Rivera, J.A.; Díez-Villanueva, P.; de Gracia, A.I.; Fuertes, E.; Oltra, M.R.; Ferrer, A.; Belmonte, A.; et al. Infective Endocarditis in the Elderly: Challenges and Strategies. J. Cardiovasc. Dev. Dis. 2022, 9, 192. [Google Scholar] [CrossRef] [PubMed]
- United Nations, Department of Economic and Social Affairs, Population Division. Available online: https://population.un.org/wpp/Download/Standard/Population/ (accessed on 30 March 2022).
- Kaczmarek, E. How to Distinguish Medicalization from Over-Medicalization? Med. Health Care Philos. 2019, 22, 119–128. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Li, J.S.; Sexton, D.J.; Mick, N.; Nettles, R.; Fowler, V.G., Jr.; Ryan, T.; Bashore, T.; Corey, G.R. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin. Infect. Dis. 2000, 30, 633–638. [Google Scholar] [CrossRef] [PubMed]
- R Core Team. R: A Language and Environment for Statistical Computing; R Foundation for Statistical Computing: Vienna, Austria, 2020; Available online: https://www.R-project.org/ (accessed on 10 January 2022).
- Mortasawi, A.; Arnrich, B.; Rosendahl, U.; Frerichs, I.; Albert, A.; Walter, J.; Ennker, J. Is age an independent determinant of mortality in cardiac surgery as suggested by the EuroSCORE? BMC Surg. 2002, 2, 8. [Google Scholar] [CrossRef] [PubMed]
- Ostovar, R.; Schröter, F.; Kühnel, R.-U.; Hartrumpf, M.; Albes, J.M. What Exactly Makes Age a Risk Factor for an Unfavorable Outcome after Mitral Valve Surgery? J. Clin. Med. 2022, 11, 6907. [Google Scholar] [CrossRef] [PubMed]
- Friedrich, I.; Simm, A.; Kötting, J.; Thölen, F.; Fischer, B.; Silber, R.E. Cardiac surgery in the elderly patient. Dtsch. Arztebl. Int. 2009, 106, 416–422. [Google Scholar] [CrossRef] [PubMed]
- Dittrich, S.; Arenz, C.; Krogmann, O.; Tengler, A.; Meyer, R.; Bauer, U.; Hofbeck, M.; Beckmann, A.; Horke, A. German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease: Re-port 2021 and 9 Years’ Longitudinal Observations on Fallot and Coarctation Patients. Thorac. Cardiovasc. Surg. 2022, 70, e21–e33. [Google Scholar] [CrossRef] [PubMed]
- Caiati, C.; Pollice, P.; Lepera, M.E.; Favale, S. Pacemaker Lead Endocarditis Investigated with Intracardiac Echocardiography: Factors Modulating the Size of Vegetations and Larger Vegetation Embolic Risk during Lead Extraction. Antibiotics 2019, 8, 228. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cabell, C.H.; Jollis, J.G.; Peterson, G.E.; Corey, G.R.; Anderson, D.J.; Sexton, D.J.; Woods, C.W.; Reller, L.B.; Ryan, T.; Fowler, V.G., Jr. Changing patient characteristics and the effect on mortality in endocarditis. Arch. Intern. Med. 2002, 162, 90–94. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Farag, M.; Borst, T.; Sabashnikov, A.; Zeriouh, M.; Schmack, B.; Arif, R.; Beller, C.J.; Popov, A.F.; Kallenbach, K.; Ruhparwar, A.; et al. Surgery for Infective Endocarditis: Outcomes and Predictors of Mortality in 360 Consecutive Patients. Med. Sci. Monit. 2017, 23, 3617–3626. [Google Scholar] [CrossRef] [PubMed]
- Knebel, F.; Frumkin, D.; Flachskampf, F.A. Infektiöse Endokarditis. Dtsch. Med. Wochenschr. 2019, 144, 114–127. (In German) [Google Scholar] [CrossRef] [PubMed]
- Varela Barca, L.; López-Menéndez, J.; Navas Elorza, E.; Moya Mur, J.L.; Centella Hernéndez, T.; Redondo Palacios, A.; Fajardo, E.R.; Miguelena Hycka, J.; Martín García, M.; Muñoz Pérez, R.; et al. Long-term prognosis after surgery for infective endocarditis: Distinction between predictors of early and late survival. Enferm. Infecc. Microbiol. Clin. Engl. Ed. 2019, 37, 435–440. (In Spanish) [Google Scholar] [CrossRef] [PubMed]
- Available online: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/dementia-highlights-canadian-chronic-disease-surveillance.html (accessed on 9 January 2023).
Preoperative Condition | Patients < 75 Years | Patients ≥ 75 Years | p-Value |
---|---|---|---|
Gender (female) | 23.2% [16.2–31.9] | 29.6% [19.1–42.8] | 0.482 |
EuroSCORE II (%) | 13.2% ±16.8% | 19.3 ± 19.7% | <0.001 |
Left ventricular ejection fraction | 52.2% ± 10.2% | 48.5% ± 10.6% | 0.017 |
Body mass index (kg/m2) | 28.9 ± 6.6 | 27.1 ± 3.9 | 0.113 |
Early endocarditis (%) | 11.1% [6.5–18.4] | 16.7% [9.0–28.7] | 0.457 |
Recurrent endocarditis | 5.6% [2.6–11.6] | 11.1% [5.2–22.2] | 0.34 |
Coronary heart disease | 37.9% [29.4–47.4] | 55.6% [42.4–68] | 0.05 |
Redo surgery | 32.4% [24.3–41.4] | 38.9% [27.0–52.2] | 0.521 |
Valve prosthesis carrier | 35.2% [26.8–44.6] | 54.7% [41.5–67.3] | 0.028 |
Electrophysiology devices | 26.9% [19.4–35.9] | 35.2% [23.8–48.5] | 0.362 |
Proportion of carcinoma | 14.8% [9.3–22.7] | 18.5% [10.4–30.8] | 0.705 |
Proportion of chemotherapy | 6.5% [3.2–12.8] | 9.3% [4.0–19.9] | 0.75 |
Glucocorticoid treatments | 14.8% [9.3–22.7] | 9.3% [4–19.9] | 0.457 |
Autoimmune diseases | 9.3% [5.1–16.2] | 7.4% [2.9–17.6] | 0.776 |
Diabetes mellitus | 33.3% [25.2–42.7] | 31.5% [20.7–44.7] | 0.953 |
Dialysis dependency | 5.6% [2.6–11.6] | 5.6% [1.9–15.1] | 1 |
Respiratory tract infection | 19.4% [13.1–27.9] | 14.8% [7.7–26.6] | 0.612 |
Urogenital infections | 12% [7.2–19.5] | 18.5% [10.4–30.8] | 0.381 |
Intra-abdominal infection | 3.7% [1.4–9.1] | 9.3% [4–19.9] | 0.161 |
Skin and soft tissue infection | 14.8% [9.3–22.7] | 13% [6.4–24.4] | 0.937 |
Bone and joint infection | 13% [7.9–20.6] | 9.3% [4–19.9] | 0.666 |
Drug abuse | 3.7% [1.4–9.1] | 1.85% [0.3–9.8] | 0.666 |
Alcohol abuse | 13% [7.9–20.6] | 7.4% [2.9–17.6] | 0.427 |
Profound dental treatments | 13.9% [8.6–21.7] | 14.8% [7.7–26.6] | 1 |
Patients < 75 Years | Patients ≥ 75 Years | p-Value | |
---|---|---|---|
Localization of the affected valve | 0.789 | ||
Aortic valve | 60.94% | 65.57% | |
Mitral valve | 29.69% | 29.51% | |
Tricuspid valve | 7.03% | 4.92% | |
Pulmonary valve | 2.34% | 0% | |
Germs | 0.746 | ||
Staphylococcus aureus | 31.37% | 20% | |
Staphylococcus epidermidis | 10.78% | 9.09% | |
Other Staphylococci | 4.9% | 3.64% | |
Enterococcus faecalis | 16.67% | 21.82% | |
Other Enterococci | 0.98% | 3.64% | |
Streptococcus mitis | 7.84% | 9.09% | |
Other Streptococci | 14.71% | 18.18% | |
Other germs | 12.75% | 14.55% | |
Multidrug resistant | 0.93% | 0% | 1 |
Fever | 75% | 79.63% | 0.646 |
SIRS | 34.26% | 46.3% | 0.189 |
Pulmonary edema | 18.52% | 18.52% | 1 |
Acute renal failure | 2.78% | 5.56% | 0.401 |
Delirium | 0.93% | 5.56% | 0.108 |
Cardiac arrhythmia | 2.78% | 7.41% | 0.223 |
Pleural effusion | 7.41% | 9.26% | 0.919 |
Heart failure | 39.81% | 44.44% | 0.693 |
Septic embolism | 42.59% | 20.37% | 0.009 |
Localization of septic embolism | 0.019 | ||
Cerebral | 38.57% | 68.75% | |
Spleen | 24.29% | 6.25% | |
Kidney | 15.71% | 0% | |
Peripheral extremities | 14.29% | 12.5% | |
Lung | 4.29% | 0% | |
Liver | 2.86% | 0% | |
Diagnostic time frame | 66.85 ± 49.53 | 50.98 ± 30.55 | 0.081 |
Preoperative laboratory findings | |||
Hemoglobin (mmol/L) | 6.94 ± 1.38 | 6.58 ± 1.06 | 0.227 |
Hematocrit | 0.33 ± 0.06 | 0.31 ± 0.05 | 0.244 |
Leukocytes (Gpt/L) | 9.74 ± 4.39 | 10.34 ± 4.61 | 0.471 |
Platelets (Gpt/L) | 243.76 ± 112.94 | 235.37 ± 112.47 | 0.605 |
CRP (mg/L) | 83.98 ± 78.65 | 89.38 ± 76.51 | 0.425 |
Prothrombin time (%) | 88.69 ± 23.21 | 78.08 ± 25.96 | 0.008 |
International normalized ratio (INR) | 1.13 ± 0.4 | 1.28 ± 0.59 | 0.007 |
NT-proBNP (pg/mL) | 6736.59 ± 10,198 | 10,291.6 ± 10,664 | 0.002 |
PCT (ng/mL) | 2.37 ± 5.67 | 3.87 ± 10.69 | 0.559 |
Creatinine (µmol/L) | 130.96 ± 118.27 | 134.37 ± 73.69 | 0.001 |
Glomerular filtration rate (mL/min) | 73.91 ± 34.69 | 54.11 ± 24.08 | <0.001 |
Albumin (g/L) | 31.32 ± 7.36 | 31.2 ± 5.06 | 0.92 |
GOT (µkat/L) | 0.82 ± 1.73 | 0.92 ± 1.18 | 0.086 |
GPT (µkat/L) | 0.61 ± 0.85 | 0.72 ± 0.73 | 0.102 |
Patients < 75 Years | Patients ≥ 75 Years | p-Value | |
---|---|---|---|
Postoperative laboratory findings | |||
Hemoglobin (mmol/L) | 5.93 ± 0.9 | 5.88 ± 1 | 0.8 |
Hematocrit | 0.28 ± 0.04 | 0.27 ± 0.04 | 0.574 |
Leukocytes (Gpt/L) | 10.62 ± 5.69 | 10.92 ± 5.37 | 0.656 |
Platelets (Gpt/L) | 251.82 ± 124.31 | 209.42 ± 113.1 | 0.063 |
CRP (mg/L) | 134.3 ± 98.38 | 112.3 ± 78.8 | 0.475 |
Prothrombin time (%) | 85.33 ± 23.68 | 82.1 ± 20.22 | 0.305 |
International normalized ratio (INR) | 1.13 ± 0.25 | 1.2 ± 0.38 | 0.196 |
PCT (ng/mL) | 3.15 ± 7.89 | 1.15 ± 3.35 | 0.301 |
Creatinine (µmol/L) | 127.95 ± 82.01 | 130.06 ± 63.63 | 0.375 |
Glomerular filtration rate (mL/min) | 71.42 ± 39.09 | 58.03 ± 32.55 | 0.123 |
Albumin (g/L) | 24.08 ± 4.92 | 23.7 ± 4.89 | 0.837 |
GOT (µkat/L) | 1.98 ± 0.39 | 1.13 ± 1.01 | 0.562 |
GPT (µkat/L) | 0.53 ± 0.97 | 0.65 ± 0.5 | 0.832 |
Postoperative complications | |||
Delirium | 20% | 42.5% | 0.013 |
CIP/CIM | 4.21% | 20.51% | 0.005 |
Bleeding | 14.74% | 21.95% | 0.435 |
Pleural effusion | 29.47% | 43.9% | 0.151 |
Low-cardiac-output syndrome | 4.21% | 10.26% | 0.23 |
Hospitalization cardiology | 10.88 ± 9.16 | 16.79 ± 15.29 | 0.004 |
Hospitalization cardiac surgery | 17.36 ± 12.64 | 18.38 ± 16.56 | 0.914 |
In-hospital mortality | 29.91% | 40.38% | 0.256 |
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Ostovar, R.; Zinab, F.S.; Schröter, F.; Hartrumpf, M.; Fritzsche, D.; Albes, J.M. Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients? J. Clin. Med. 2023, 12, 822. https://doi.org/10.3390/jcm12030822
Ostovar R, Zinab FS, Schröter F, Hartrumpf M, Fritzsche D, Albes JM. Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients? Journal of Clinical Medicine. 2023; 12(3):822. https://doi.org/10.3390/jcm12030822
Chicago/Turabian StyleOstovar, Roya, Farzaneh Seifi Zinab, Filip Schröter, Martin Hartrumpf, Dirk Fritzsche, and Johannes Maximilian Albes. 2023. "Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?" Journal of Clinical Medicine 12, no. 3: 822. https://doi.org/10.3390/jcm12030822
APA StyleOstovar, R., Zinab, F. S., Schröter, F., Hartrumpf, M., Fritzsche, D., & Albes, J. M. (2023). Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients? Journal of Clinical Medicine, 12(3), 822. https://doi.org/10.3390/jcm12030822