Clinical Features And Outcomes Of Streptococcus Anginosus Group Infective Endocarditis: A Multicenter Matched Cohort Study

Abstract Background Although Streptococcus anginosus group (SAG) endocarditis is considered a severe disease associated with abscess formation and embolic events, there is limited evidence to support this assumption. Methods We performed a retrospective analysis of prospectively collected data from consecutive patients with definite SAG endocarditis in 28 centers in Spain and Italy. A comparison between cases due to SAG endocarditis and viridans group streptococci (VGS) or Streptococcus gallolyticus group (SGG) was performed in a 1:2 matched analysis. Results Of 5,336 consecutive cases of definite endocarditis, 72 (1.4%) were due to SAG and matched with 144 cases due to VGS/SGG. SAG endocarditis was community acquired in 64 (88.9%) cases and affected aortic native valve in 29 (40.3%). When comparing SAG and VGS/SGG endocarditis, no significant differences were found in septic shock (8.3% vs. 3.5%, P = 0.116); valve disorder, including perforation (22.2% vs. 18.1%, P = 0.584), pseudoaneurysm (16.7% vs. 8.3%, P = 0.108), or prosthesis dehiscence (1.4% vs. 6.3%, P = 0.170); paravalvular complications, including abscess (25% vs. 18.8%, P = 0.264) and intracardiac fistula (5.6% vs. 3.5%, P = 0.485); heart failure (34.7% vs. 38.9%, P = 0.655); and embolic events (41.7% vs. 32.6%, P = 0.248). Indications for surgery (70.8% vs. 70.8%; P =1) and mortality (13.9% vs. 16.7%; P = 0.741) were similar between groups. Conclusions SAG endocarditis is an infrequent but serious condition that presents a prognosis similar to that of VGS/SGG

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Faculty Opinions recommendation of Association between renin-angiotensin system inhibitor use and mortality/morbidity in elderly patients with heart failure with reduced ejection fraction: a prospective propensity score-matched cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734280254.793552372 ◽

2018 ◽

Author(s):

Juan-Carlos Kaski ◽

Amelia Carro

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Propensity Score ◽

Ejection Fraction ◽

Elderly Patients ◽

Renin Angiotensin System ◽

Matched Cohort ◽

Angiotensin System ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

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Heart failure in septic shock

Critical Care Medicine ◽

10.1097/00003246-199001002-00010 ◽

1990 ◽

Vol 18 (Supplement) ◽

pp. S56 ◽

Cited By ~ 19

Author(s):

BRUNO SCHREMMER ◽

JEAN-FRANÇOIS DHAINAUT

Keyword(s):

Heart Failure ◽

Septic Shock

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Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/08850666211061472 ◽

2021 ◽

pp. 088506662110614

Author(s):

Mohinder R. Vindhyal ◽

Liuqiang (Kelsey) Lu ◽

Sagar Ranka ◽

Prakash Acharya ◽

Zubair Shah ◽

...

Keyword(s):

Heart Failure ◽

Septic Shock ◽

Congestive Heart Failure ◽

Hospital Mortality ◽

Secondary Analysis ◽

Kidney Injury ◽

Cross Sectional ◽

Increased Risk ◽

Icd 10 ◽

Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

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Dissemination of extreme levels of extracellular vesicles: tissue factor activity in patients with severe COVID-19

Blood Advances ◽

10.1182/bloodadvances.2020003308 ◽

2021 ◽

Vol 5 (3) ◽

pp. 628-634

Author(s):

Christophe Guervilly ◽

Amandine Bonifay ◽

Stephane Burtey ◽

Florence Sabatier ◽

Raphaël Cauchois ◽

...

Keyword(s):

Septic Shock ◽

Tissue Factor ◽

Extracellular Vesicles ◽

Severe Disease ◽

Plasminogen Activator Inhibitor ◽

Hospitalized Patients ◽

Plasminogen Activator Inhibitor 1 ◽

Thrombotic Risk ◽

Public Health Challenges ◽

Inflammatory State

Abstract Coronavirus disease 2019 (COVID-19) has become one of the biggest public health challenges of this century. Severe forms of the disease are associated with a thrombo-inflammatory state that can turn into thrombosis. Because tissue factor (TF) conveyed by extracellular vesicles (EVs) has been implicated in thrombosis, we quantified the EV-TF activity in a cohort of hospitalized patients with COVID-19 (n = 111) and evaluated its link with inflammation, disease severity, and thrombotic events. Patients with severe disease were compared with those who had moderate disease and with patients who had septic shock not related to COVID-19 (n = 218). The EV-TF activity was notably increased in patients with severe COVID-19 compared with that observed in patients with moderate COVID-19 (median, 231 [25th to 75th percentile, 39-761] vs median, 25 [25th to 75th percentile, 12-59] fM; P < .0001); EV-TF was correlated with leukocytes, D-dimer, and inflammation parameters. High EV-TF values were associated with an increased thrombotic risk in multivariable models. Compared with patients who had septic shock, those with COVID-19 were characterized by a distinct coagulopathy profile with significantly higher EV-TF and EV-fibrinolytic activities that were not counterbalanced by an increase in plasminogen activator inhibitor-1 (PAI-1). Thus, this article is the first to describe the dissemination of extreme levels of EV-TF in patients with severe COVID-19, which supports the international recommendations of systematic preventive anticoagulation in hospitalized patients and potential intensification of anticoagulation in patients with severe disease.

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The Molecular and Cellular Mechanisms Associated with a Microvascular Inflammation in the Pathogenesis of Heart Failure with Preserved Ejection Fraction

Acta Naturae ◽

10.32607/actanaturae.10990 ◽

2020 ◽

Vol 12 (2) ◽

pp. 40-51

Author(s):

A. G. Ovchinnikov ◽

T. I. Arefieva ◽

A. V. Potekhina ◽

A. Yu. Filatova ◽

F. T. Ageev ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Severe Disease ◽

Treatment Options ◽

Cellular Mechanisms ◽

Reduced Ejection Fraction ◽

Hypertrophied Myocardium ◽

Microvascular Inflammation ◽

Novel Strategy ◽

Current Paradigm

Heart failure withpreserved ejection fraction (HFpEF) is a severe disease with an often unfavorable outcome. The prevalence of HFpEF continues to increase, while effective treatment options remain elusive. All the medical strategies used toimprove the outcome in a heart failure with reduced ejection fraction proved ineffective in HFpEF, which was probably due to the different mechanisms ofdevelopment of these two types of heart failure and the diversity of the HFpEF phenotypes. According to the current paradigm of HFpEF development, a chronic mild pro-inflammatory statecauses a coronary microvascular endothelial inflammation, with further myocardial fibrosis and diastolic dysfunction progression. This inflammatory paradigm of HFpEF has been confirmed with someevidence, and suppressing the inflammation may become a novel strategy for treating and managing HFpEF. This review summarizes current concepts about a microvascular inflammation in hypertrophied myocardium and provides a translational perspective of the anti-inflammatory and immunomodulatory approaches in HFpEF.

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Life-threatening complications of pulmonary hypertension

ESC CardioMed ◽

10.1093/med/9780198784906.003.0580 ◽

2018 ◽

pp. 2497-2500

Author(s):

Marion Delcroix ◽

Catharina Belge

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Coronary Artery ◽

Pulmonary Arterial Hypertension ◽

Severe Disease ◽

Right Heart Failure ◽

Artery Dissection ◽

Life Threatening ◽

Pulmonary Arterial ◽

Arterial Dilation

Pulmonary arterial hypertension is a severe disease with a 1-year mortality of over 10%. Since it is a rare disease, it is usually managed in expert centres. However, life-threatening complications can occur at any moment and place and should be adequately taken care of to prevent avoidable deaths. Therefore, based on an analysis of the causes of death, this chapter describes the most important complications and their management: right heart failure, arrhythmias, haemoptysis, pericardial effusion, pulmonary arterial dilation with as a consequence left main coronary artery compression, and pulmonary artery dissection, as well as treatment-related adverse events.

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Excess length of hospital stay, mortality and cost attributable to Clostridioides (Clostridium) difficile infection and recurrence: a nationwide analysis in Japan

Epidemiology and Infection ◽

10.1017/s0950268820000606 ◽

2020 ◽

Vol 148 ◽

Author(s):

T. Kimura ◽

S. Stanhope ◽

T. Sugitani

Keyword(s):

Hospital Stay ◽

Excess Mortality ◽

Length Of Hospital Stay ◽

Administrative Database ◽

Matched Cohort ◽

Limited Evidence ◽

Immortal Time Bias ◽

Hospitalised Patients ◽

Substantial Economic Burden ◽

Support Decision Making

Abstract Clostridioides (Clostridium) difficile infection (CDI) is the leading cause of infectious diarrhoea in hospitalised patients, representing a substantial economic burden driven mainly by increased length of hospital stay (LoS). Currently in Japan, limited evidence on CDI-associated excess LoS is available. We conducted a retrospective, matched-cohort study using a large, Japanese, hospital-based administrative database. CDI was defined as CDI treatment plus either CDI diagnosis or positive enzyme immunoassay result. Propensity score matching at the time of CDI or recurrent CDI (rCDI) onset was applied to adjust baseline confounding and immortal time bias. The analysis included 5 994 054 hospitalisation records during 2008–2017, of which 11 823 were identified as CDI and 1359 as rCDI. The median excess LoS attributable to CDI and rCDI was 3 days and 6.5 days, respectively. The excess mortality attributable to CDI was 6.9%; there was no excess mortality attributable to rCDI (−1.9%). The median difference in costs attributable to CDI and rCDI during the residual stay was JPY 130 296 (USD 1185) and JPY 81 054 (USD 737) per hospitalisation, respectively. By adjusting the biases, the burden of CDI in Japan was evaluated. The findings could support decision making and resource allocation for CDI management in Japanese hospitals.

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079: Heart failure in native valve infective endocarditis: characteristics, prognosis, and results of surgical treatment

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(13)71009-7 ◽

2013 ◽

Vol 5 (1) ◽

pp. 26

Author(s):

Mohamed Majed Hassine ◽

Mejdi Ben Messaoud ◽

Fatma Ben Amor ◽

Ismail Ghrissi ◽

Mehdi Khlif ◽

...

Keyword(s):

Heart Failure ◽

Surgical Treatment ◽

Infective Endocarditis ◽

Native Valve

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The microbiology of the acute dental abscess

Journal of Medical Microbiology ◽

10.1099/jmm.0.003517-0 ◽

2009 ◽

Vol 58 (2) ◽

pp. 155-162 ◽

Cited By ~ 114

Author(s):

D. Robertson ◽

A. J. Smith

Keyword(s):

Hospital Admissions ◽

Odontogenic Infections ◽

Culture Techniques ◽

Streptococcus Anginosus ◽

Dental Abscess ◽

Relevant Today ◽

Causative Agents ◽

Severe Infections ◽

Viridans Group Streptococci ◽

Insight Into

The acute dental abscess is frequently underestimated in terms of its morbidity and mortality. The risk of potential serious consequences arising from the spread of a dental abscess is still relevant today with many hospital admissions for dental sepsis. The acute dental abscess is usually polymicrobial comprising facultative anaerobes, such as viridans group streptococci and the Streptococcus anginosus group, with predominantly strict anaerobes, such as anaerobic cocci, Prevotella and Fusobacterium species. The use of non-culture techniques has expanded our insight into the microbial diversity of the causative agents, identifying such organisms as Treponema species and anaerobic Gram-positive rods such as Bulleidia extructa, Cryptobacterium curtum and Mogibacterium timidum. Despite some reports of increasing antimicrobial resistance in isolates from acute dental infection, the vast majority of localized dental abscesses respond to surgical treatment, with antimicrobials limited to spreading and severe infections. The microbiology and treatment of the acute localized abscess and severe spreading odontogenic infections are reviewed.

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