Procjena težine sepse i utjecaj na ishod bolesnika s infektivnim endokarditisom [Sepsis severity estimation and influence on outcome of patients with infective endocarditis]

Krajinović, Vladimir (2014) Procjena težine sepse i utjecaj na ishod bolesnika s infektivnim endokarditisom [Sepsis severity estimation and influence on outcome of patients with infective endocarditis]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Introduction: Infective endocarditis (IE) is a disease with high mortality because of numerous complications. Little is known about the impact of different stages of sepsis on the outcome in patients with IE, as well as surgical treatment in this group of patients. Objective: To assess the relationship between different stages of sepsis and outcome in patients with IE and to analyze influence of surgical treatment on the outcome in most severe stages of sepsis. Design: Prospective, cohort study. Setting: University Hospital for Infectious Diseases, Zagreb. Patients: Definite diagnosis of IE, ≥ 18 years, 2000 - 2011. Methods: Uni and multivariate analysis. Outcomes: In-hospital survival, one-year and five-year survival, timing of surgery, relapse IE. Results: Severe sepsis and septic shock (SSSS) showed no statistical relationship with increased in-hospital mortality (OR 1.167, p=0.807), while the high SOFA score was a factor with the strongest relationship with high in-hospital mortality (OR 1.306, p<0.001). Surgical treatment has positive influence on in-hospital survival in patients with SSSS and IE (OR 0.179, p=0.002) as well as on one-year survival (HR 0.339, p=0.001) and five-year survival (HR 0.313, p<0.001). Conclusions: The presence of SSSS as an independent variable has no influence on outcome in patients with IE, unless it is associated with severe multiorgan failure with high SOFA score. Surgical treatment has a positive effect on outcome (in-hospital, one-year and five-year) especially in the SSSS group of patients.

Abstract in Croatian

Uvod: Infektivni endokarditis (IE) bolest je karakterizirana visokom smrtnošću zbog brojnih komplikacija. Malo je poznato o utjecaju različitih stadija težine sepse na ishod bolesti kao i o primjeni kirurškog liječenja u ovoj skupini bolesnika s IE. Cilj: Utvrditi povezanost različitih stadija sepse i ishoda IE i analizirati utjecaj kirurškog liječenja na ishod u bolesnika s najtežim oblicima sepse. Ustroj: Prospektivno, kohortno istraživanje. Mjesto: Klinika za infektivne bolesti u Zagrebu. Bolesnici: Definitivna dijagnoza IE, ≥18 godina, 2000. – 2011. god. Metode: Uni- i multivarijatna analiza. Varijable ishoda: Bolničko preživljenje bolesnika, jednogodišnje i petogodišnje preživljenje, vrijeme provođenja kirurškog zahvata, relaps IE. Rezultati: Teška sepsa i septički šok nisu pokazali statistički značajnu povezanost s povećanom bolničkom smrtnošću (OR 1,167, p=0,807), dok je visoki SOFA skor čimbenik najjače povezan s povećanom bolničkom smrtnošću (OR 1,306, p<0,001). Kirurško liječenje pozitivno utječe na bolnički ishod u bolesnika s TSSŠ i IE (OR 0,179, p=0,002) kao i na jednogodišnje (HR 0,339, p=0,001) i petogodišnje preživljenje (HR 0,313, p<0,001). Zaključak: Prisustvo teške sepse i/ili septičkog šoka kao neovisne varijable ne utječe na ishod bolesnika s IE osim ako se ne radi o težoj multiorganskoj disfunkciji obilježenoj visokim SOFA skorom. Kardiokirurško liječenje ima izražen pozitivan efekt na ishod (bolnički, jednogodišnji i petogodišnji) bolesti osobito u skupini bolesnika s TSSŠ.

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