scholarly journals Prognosis of short- and long-term dialysis in patients with infective endocarditis: a nationwide study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Petersen ◽  
A.D Jensen ◽  
N.E Bruun ◽  
A Kamper ◽  
J.W Butt ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Dialysis Patients ◽  
Term Survival ◽  
Dialysis Treatment ◽  
Increased Risk ◽  
Short And Long Term ◽  
Continued Use ◽  
One Year

Abstract Background Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. We set out to examine the prognosis of short- and long-term dialysis in patients with IE. Methods Using Danish nationwide registries we identified patients with first-time IE from 2000 to 2017. Dialysis naïve patients were grouped into: those who were treated with dialysis during admission with IE and those who were not. The cumulative incidence of continuous use of dialysis was examined one year post-discharge Multivariable adjusted Cox proportional hazard analysis was used to examine one-year mortality for patients surviving IE based on use of dialysis. Results We included 7,307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery during admission with IE compared with non-dialysis patients (47.4% vs. 20.9%). In patients with both surgical intervention and dialysis treatment, 153 (77.7%) initiated dialysis on- or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (p<0.0001). Of those who started dialysis and survived hospitalisation, 78.4% became dialysis-free within one year after discharge. Among those who survived one week subsequent to IE discharge, we identified 5,520 who never had dialysis, 204 patients without continued use of dialysis, and 40 patients with a continued use of dialysis. The corresponding mortality risk at one year was 15.2%, 13.5%, and 41.6% (Figure), respectively. Compared with patients not treated with dialysis, those who became dialysis-free at discharge showed no increased risk of one year mortality in adjusted analysis (HR=1.45, 95% CI: 0.97–2.20), while patients who continued dialysis had an increased associated risk of mortality (HR=2.00, 95% CI: 1.20–3.33). Conclusion In dialysis-naïve patients with IE, more than 1 in 20 patients initiated dialysis treatment during admission. Dialysis identified a high-risk group with an in-hospital mortality of 40%–twice as high as their counterparts. In dialysis patients surviving admission with IE, almost 80% became dialysis-free and showed better long-term survival than those who continued dialysis after discharge. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 19408: Impact of Perioperative Liver Dysfunction on In-hospital Mortality and Long-term Survival in Infective Endocarditis Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mahmoud Diab ◽  
Christoph Sponholz ◽  
Michael Bauer ◽  
Andreas Kortgen ◽  
Philipp Scheffel ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Liver Dysfunction ◽  
Cox Regression ◽  
Term Survival ◽  
Long Term Survival ◽  
Aureus Infection

Background: Infective endocarditis (IE) is a dangerous disease with high mortality (20-40%). A leading cause of death is multi-organ failure (MODS) with liver dysfunction (LD) as major contributor. Data on LD in IE patients are scarce. We assessed the impact of preoperative - and newly occurring LD on in-hospital mortality and long-term survival in IE patients. Methods: We retrospectively reviewed our database for surgery of left-sided endocarditis between 1/07 and 4/13. We used the hepatic Sepsis-related Organ Failure Assessment (hSOFA) score to assess the degree of LD. We performed Chi-Square, Cox regression and multivariate analyses. Results: The 308 patients had a mean age of 62 ±13.9. Preoperative LD (hSOFA > 0, Bilirubin > 32 μmol/L) was present in 1/4 (n=81) of patients and was associated with severely elevated in-hospital mortality (51.9% vs.14.6% without preoperative LD, p<0.001). Newly-occurring postoperative LD developed in another quarter (n=57 of 227 patients without LD) of patients and was associated with elevated in-hospital mortality (24.6% vs. 11.2%, p<0.001). Kaplan-Meyer 5-year survival was significantly better in patients without LD (51% vs. 19.9%, p<0.01). Survival curves were practically identical after the perioperative phase was over (Fig.). Quality of life in survivors was also the same. Cox regression analysis revealed preoperative LD as independent predictor of long-term survival (adjusted hazard ratio 1.695, 95% confidence interval 1.160-2.477, p=0.009) and duration of cardiopulmonary bypass (CPB) and S. aureus infection as independent predictors of newly-occurring postoperative LD. Conclusions: LD in patients with endocarditis is a significant independent risk factor for in-hospital mortality. A considerable fraction of patients develop LD perioperatively, which is associated with cardiopulmonary bypass-duration and S. aureus infection. However, after surviving surgery, prognosis no longer seems to be predicted by LD.

Outcome of dialysis-requiring acute kidney injury in patients with infective endocarditis: A nationwide study

2020 ◽  
Author(s):  
Jeppe Kofoed Petersen ◽  
Andreas Dalsgaard Jensen ◽  
Niels Eske Bruun ◽  
Anne-Lise Kamper ◽  
Jawad Haider Butt ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Valve Surgery ◽  
Cardiac Valve ◽  
Post Discharge ◽  
Dialysis Treatment ◽  
Cardiac Valve Surgery ◽  
One Year

Abstract Background Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. Methods Using Danish nationwide registries, we identified patients with first-time IE from 2000 to 2017. Dialysis naïve patients were grouped into: those with and those without dialysis during admission with IE. Continuation of dialysis was followed one year post-discharge. Multivariable adjusted Cox proportional hazard analysis was used to examine one-year mortality for patients surviving IE according to use of dialysis. Results We included 7,307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery compared with non-dialysis patients (47.4% vs. 20.9%). In patients with both cardiac valve surgery and dialysis treatment (n=197), 153 (77.7%) initiated dialysis on- or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (p&lt;0.0001). Of those who started dialysis and survived hospitalization, 21.6% continued dialysis treatment within one year after discharge. In multivariable adjusted analysis, dialysis during admission with IE was associated with an increased one-year mortality from IE discharge, HR=1.64 (95% CI: 1.21-2.23). Conclusion In dialysis-naïve patients with IE, approximately 1 in 20 patients initiated dialysis treatment during admission with IE. Dialysis identified a high-risk group with an in-hospital mortality of 40% and an approximately 20% risk of continued dialysis. Those with dialysis during admission with IE showed worse long-term outcomes than those without.

Impact of perioperative liver dysfunction on in-hospital mortality and long-term survival in infective endocarditis patients

Infection ◽  
2017 ◽  
Vol 45 (6) ◽  
pp. 857-866 ◽  
Author(s):  
M. Diab ◽  
C. Sponholz ◽  
C. von Loeffelholz ◽  
P. Scheffel ◽  
M. Bauer ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Liver Dysfunction ◽  
Term Survival ◽  
Long Term Survival

Prediction of in-hospital Mortality and Long-term Survival in Patients Operated for Infective Endocarditis

2015 ◽  
Vol 63 (S 01) ◽  
Author(s):  
M. Diab ◽  
P. Scheffel ◽  
C. Sponholz ◽  
T. Lehmann ◽  
I. Löhn ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Term Survival ◽  
Long Term Survival

Multivalve Infective Endocarditis In Intravenous Drug Using Patients: An Epidemiological Study

QJM ◽  
2021 ◽  
Author(s):  
Isa Khan ◽  
Elizabeth Brookes ◽  
Nima Yaftian ◽  
Andrew Wilson ◽  
Jonathan Darby ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infective Endocarditis ◽  
Social Issues ◽  
High Rate ◽  
Intravenous Drug ◽  
Term Survival ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background Infective endocarditis (IE) remains a life-threatening condition. Intravenous drug use (IVDU) adds to the clinical challenge associated with IE due to clinical aberrations caused by the social issues associated with this population. Aim To improve survival this study aimed to characterise the contemporary IVDU associated IE population seen at our tertiary hospital, determine their long-term outcomes, and find risk factors associated with mortality. Design Retrospective observational cohort study. Methods 79 patients accounting for 89 presentations were treated for IVDU associated IE at St Vincent’s Hospital Melbourne (SVHM) between 1999 and 2015. Patients were followed up until death or January 2021. The primary outcome was all-cause mortality and Kaplan-Meier survival analysis was used to calculate long-term survival estimates. Cox proportional hazards analysis was used to examine risk factors for mortality. Results The IVDU population treated at SVHM had a high rate of multivalvular IE, at 18.98%. Multivariate analysis revealed that multivalvular IE is significantly associated with an increased risk of mortality in a dose-dependent relationship (two valves affected: HR = 4.73, P = 0.006, three valves affected: HR = 14.19, P = 0.014). The IVDU population has survival estimates of 83.78% (95%CI: 73.21-90.45%) at 1-year and 64.98% (95%CI: 50.94-75.92%) at 15-years. Conclusion IVDU patients have high rates of multivalvular endocarditis, which is associated with increased risk of mortality and difficult to identify on echocardiography. Clinicians should be suspicious of multivalve involvement in the IVDU population and decisions related to medical management/intervention should be made with the understanding that these patients are at a higher risk of death.

Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

2012 ◽  
Vol 15 (1) ◽  
pp. 4 ◽  
Author(s):  
David M. Holzhey ◽  
William Shi ◽  
A. Rastan ◽  
Michael A. Borger ◽  
Martin H�nsig ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Survival Rates ◽  
Long Term Results ◽  
Term Survival ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Short And Long Term ◽  
Good Treatment Option ◽  
Matched Comparison

<p><b>Introduction:</b> The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).</p><p><b>Patients and Methods:</b> All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.</p><p><b>Results:</b> The 30-day mortality rate was 10.8% and 8.4% (<i>P</i> = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, <i>P</i> = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, <i>P</i> = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).</p><p><b>Conclusion:</b> Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.</p>

scholarly journals Short- and long-term effects of ponderosa pine fuel treatments intersected by the Egley Fire Complex, Oregon, USA

Fire Ecology ◽  
2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Jessie M. Dodge ◽  
Eva K. Strand ◽  
Andrew T. Hudak ◽  
Benjamin C. Bright ◽  
Darcy H. Hammond ◽  
...  
Keyword(s):  
Prescribed Fire ◽  
Vegetation Cover ◽  
Tree Density ◽  
Tree Canopy ◽  
Fuel Treatments ◽  
Dead Tree ◽  
High Severity ◽  
Short And Long Term ◽  
One Year

Abstract Background Fuel treatments are widely used to alter fuels in forested ecosystems to mitigate wildfire behavior and effects. However, few studies have examined long-term ecological effects of interacting fuel treatments (commercial harvests, pre-commercial thinnings, pile and burning, and prescribed fire) and wildfire. Using annually fitted Landsat satellite-derived Normalized Burn Ratio (NBR) curves and paired pre-fire treated and untreated field sites, we tested changes in the differenced NBR (dNBR) and years since treatment as predictors of biophysical attributes one and nine years after the 2007 Egley Fire Complex in Oregon, USA. We also assessed short- and long-term fuel treatment impacts on field-measured attributes one and nine years post fire. Results One-year post-fire burn severity (dNBR) was lower in treated than in untreated sites across the Egley Fire Complex. Annual NBR trends showed that treated sites nearly recovered to pre-fire values four years post fire, while untreated sites had a slower recovery rate. Time since treatment and dNBR significantly predicted tree canopy and understory green vegetation cover in 2008, suggesting that tree canopy and understory vegetation cover increased in areas that were treated recently pre fire. Live tree density was more affected by severity than by pre-fire treatment in either year, as was dead tree density one year post fire. In 2008, neither treatment nor severity affected percent cover of functional groups (shrub, graminoid, forb, invasive, and moss–lichen–fungi); however, by 2016, shrub, graminoid, forb, and invasive cover were higher in high-severity burn sites than in low-severity burn sites. Total fuel loads nine years post fire were higher in untreated, high-severity burn sites than any other sites. Tree canopy cover and density of trees, saplings, and seedlings were lower nine years post fire than one year post fire across treatments and severity, whereas live and dead tree basal area, understory surface cover, and fuel loads increased. Conclusions Pre-fire fuel treatments effectively lowered the occurrence of high-severity wildfire, likely due to successful pre-fire tree and sapling density and surface fuels reduction. This study also quantified the changes in vegetation and fuels from one to nine years post fire. We suggest that low-severity wildfire can meet prescribed fire management objectives of lowering surface fuel accumulations while not increasing overstory tree mortality.

scholarly journals Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3390
Author(s):  
Mats Enlund
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Retrospective Studies ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
One Year

Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

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