عنوان
پدید آورنده
موضوع
رده
کتابخانه
محل استقرار
98993P
انگلیسی
Preediction of Outcome of Endocarditis with C-Reactive Protein (CRP) in Patients Admitted to Imam Khomeini Hospital from 1397-1401
پیش بینی نتیجه آندوکاردیت با پروتئین واکنشی C در بیماران بستری در بیمارستان امام خمینی (ره) طی سالهای 1397-1401
[Dissertation]
Naeemah Altaf
نعیمه الطاف
Tehran University of Medical Sciences, Medicine school
2023
50p
Doctor of Medicine (MD)
دکتری پزشکی عمومی
1401/12/13
1401/12/13
18
18
BACKGROUND: Infective endocarditis (IE) is a life-threatening disease and its prognosis is often difficult to predict based on clinical data. Despite the advancement in medical tools, infective endocarditis still remains a major concern. In recent years, the prevalence of IE is increasing due to IV drug abuse and iatrogenic methods with a change in epidemiology, doubling the average age of patients. Early diagnosis and risk-stratification among infective endocarditis (IE) patients are limited by poor microbiological yield and inadequate characterization of vegetations. A simple tool that can predict adverse outcomes in the early phase of management is required and that is CRP which is one of the best laboratories predictive markers used for the diagnosis of infective endocarditis and is used as a prognostic e for hospital admission and in predicting various clinical outcomes. The current study seeks to evaluate the prediction of infective endocarditis outcome with CRP. New biomarkers like cytokines, chemokines and growth factors measured at IE diagnosis can identify patients at risk for death and for analyzing these automatic systems like computer studies were used in which the cytokines, chemokines and growth factors were analyzed together with C-reactive protein (CRP) which are required to improve patient management and outcome. Proinflammatory cytokines interleukin (IL)-15͟˃ 5.6 and C-C motif chemokine ligand (CCL4) ͟͟˃ 6.35 were found to predict death, adding value to CRP ≥ 72 levels with other inflammatory biomarkers like ESR or red blood cell distribution width (RDW) are widely used in the prediction of in-hospital and long-term poor outcomes in patients with blood culture-negative infective endocarditis (BCNE) and it’s found that patients with combination of high CRP and high RDW or CRP separately high has the highest incidence of in-hospital death in BCNE. CRP is this much important in IE that its normalization has proved to be a good predictor of a favorable late outcome (surgery, death) of IE. Even low concentration of CRP (< 20 mg/L) can hardly diagnosis a patient with bacterial infective endocarditis (IE) except when some underlying conditions are present in patients and their 1-year mortality is near zero. So, for the definite diagnosis of IE according to Duke’s criteria a specific concentration of CRP is definitely needed for the final diagnosis of IE and prediction of mortality by it. Besides, above conditional cases, CRP is furthermore needed as an accurate biomarker at hospital discharge to identify patients with acute infective endocarditis (IE) who are at high risk of mortality and it has observed that a high CRP at discharge suggests a poor prognosis for 1-year mortality and paravalvular abscess and vice versa. So, in nutshell, we analyzed CRP concentration as a key marker for the diagnosis, for prediction of mortality, for late outcomes, for comorbidities, etc. and this study helped us in investigation of CRP levels and its relationship with infective endocarditis outcomes.METHOD: Our method is a cross sectional retrospective study in which we will study patient files from "Archive Section" to check either these patients died in hospital or had complications which includes all medical records and lab data of patients in Imam Khomeini Hospital. Total of 52 patients were studied, who were following our inclusion criteria. This study aimed to find the infective endocarditis outcomes with relation to CRP levels. while going through different aspects/variables like age, kinds of IE, size of vegetations, valve involvement, biomarker levels (CRP, ESR, RDW) of patients with definitive infective endocarditis according to Duke’s criteria which were referred to Imam Khomeini Hospital from year 1397 - 1401.RESULT: In this cross-sectional study, the goal was to find out the prediction of outcome of endocarditis with CRP in patients who were referred to Imam Khomeini Hospital from year 1397-1401. In this study total of 200 patients, 52 patients were studied and taken into consideration and variables like age, CRP level, mortality, size of vegetation, kind of infective endocarditis, involved value, heart failure, abscesses (heart, cerebral, splenic), embolic phenomenon (infarcts in lungs, brain or visceral organs), limb ischemia, serious arrhythmias, pericardial tamponade were also observed. Patients with IE usually come with the symptoms of fever, chest pain, malaise or dyspnea, etc. So for the definitive diagnosis of it we used Duke’s Criteria and we evaluated systemic predisposing factors and past medical history and we got results like out of 52 studied patients, 36(69.2%) were males and 16(30.2%) were females, predisposing factor like HCV(3.8%) ; HCV+HIV(1.9); previous endocarditis in 15.45%; past medical history; includes angiography (1.9%), AS(1.9), CAD(1.9%), COA(1.9%); heart rheumatism(1.9%), stent(1.9%), TOF(1.9%), VSD(1.9%) and some of the major predisposing factors like Intravenous drug users (IDU) (23.1) and hemodialytic patients( mostly due to ERSD) have proved to be the main reasons for causing infective endocarditis and other predisposing factors which are only related to heart, have caused IE are biological MVR(1.9%), prosthetic Valve(15.4%) and prosthetic valve 10 Y ago(5.8%). We also checked the type of onset of IE and we saw that most of them are health care associated (57.7%) then community associated (32.7%) and least to nosocomial (5.8%). Two of the major groups in Duke’s Criteria for definitive diagnosis of IE is echocardiography findings which was positive almost in all cases and other was blood culture which was negative (57.7%) and those cases in which blood culture was positive the organism mostly present was Staph Coagulase negative in 13.5%, then staph aureus (5.8%) and also organisms like klebsiella pneumonia (3.8%), enterococcus faecalis (3.8%), Candida (1.9%), etc. We also analyzed that most of IE patients have murmur (42.3%) present and we also checked the initial laboratory reports mean which indicated that mean age group with IE 45.0 years with maximum of 78 years, mean temperature was 37.3 ͦC. The lab tests like WBC (mean= 10.8), BUN (mean=34.50), Cr(mean=1.90), AST (mean=41.99), ALT (mean=46.32), ALP (mean=253.48), ESR (mean=63.77) all of them were high initially indicated that they all are involved in IE. We confirmed that initial CRP mean is 92.65 and maximum of it is 176 which made us sure then CRP levels are mostly related to IE which was main goal of our study i.e., higher the CRP higher the chances of IE in patients, more associated are complications and more probability of death. We also divide CRP of patients into two groups and we observed that group with CRP ˃ 90 is less (46.9%) than group with CRP≤90 (53.1%) Our study also observed echocardiography that vegetation in some of the valves like mitral (30.8%), aortic (25.0%) and both AV;MV (11.5%) is more compared to tricuspid(9.6%), pulmonary(3.8%), mural(3.8%) or their combination and we also observed patients according to vegetation size group; we analyzed that vegetation size≥10 is seen more in patients than vegetation size less than 10(24.4%). After studying all other parameters of our study, most of patients (78.8%) had undergone surgery and we finally had outcomes like patients survived without complications (42.3%); patient survived but with complications (32.7%) and those who expired (25.0%). We also observed mean age Groups; 43.21 have survived and 50.38 have expired and in the same way mean initial CRP Groups; 86.57 have survived and 111.42 have expired.CONCLUSION: So, our main aim of study to predict outcomes of endocarditis with CRP have been observed and it seemed that CRP levels are directly related to outcomes of IE. With course; if CRP levels increases then severity of diseases and the probability of complication and death increases and vice versa. Association of all variables with outcome were non-significant but that of vegetation size (p-Value=0.05) and CRP Progress in 2 weeks (p-Value˂0.001) were significantly different. On comparing with literature review, showed that CRP levels are directly related to different outcomes of Infective Endocarditis.
