Doctors appear to be particularly affected by psychological disorders or addictions and medical students are paradoxically less likely than the general population to receive appropriate care. Universities must provide monitoring and support for students in order to improve their health, but also to enable them to provide care and appropriate educational messages to their patients.
Background
Data on infectious endocarditis (IE) in patients with liver cirrhosis (LC) are sparse. We aimed to describe the characteristics and predictors of mortality from IE in patients with LC.
Patients and methods
Overall, 101 patients with LC and 101 controls with IE matched for sex, age, date of IE, and diabetes were retrospectively selected in 23 liver units between 2000 and 2013.
Results
Mean age was 60.8±10.5 and 60.6±11.5 years in LC and controls, respectively. Causes of cirrhosis (Child–Pugh A/B/C: 10.4%/41.7%/47.9%, MELD score: 17±7.8) were excess alcohol intake (79.6%), viral hepatitis (17.3%), and metabolic syndrome (14.3%). Previous history of cardiopathy was found in 24.8% of LC (prosthetic valve 8.9%) and 37.6% of controls (P=0.07). The most frequent bacteria involved were gram-positive cocci. LC had significantly fewer aminoglycosides (P=0.0007), rifamycin (P=0.03), and valve surgery (P=0.02) than controls. The proportion of patients who died following cardiac surgery was similar between the two groups (9.7% for LC vs. 8.7% for controls, P=1). In-hospital mortality for Child–Pugh C patients was significantly higher than controls (61.4 vs. 23%, P<0.001), but not for Child–Pugh A (33.3%) or B patients (25.0%). A Child–Pugh score of above C10 was the best predictor of in-hospital mortality. In LC, Child–Pugh score (odds ratio=1.5; 95% confidence interval: 1.2–2.0; P=0.002) and history of decompensation (odds ratio=3.1; 95% confidence interval: 1.1–9.0; P=0.003) were independent predictive factors for in-hospital mortality.
Conclusion
Severe liver failure but not cirrhosis is the strongest predictive factor of mortality related to IE in LC. Use of aminosides and rifamycin should be reassessed in LC, and cardiac surgery should be considered for selected patients.
Vous me faites l'honneur de juger et présider cette thèse. Soyez assuré de ma plus profonde reconnaissance et de mon plus sincère respect. Merci pour ces quatre années d'internat au cours desquelles vous m'avez transmis vos connaissances et votre passion pour la pneumologie. J'espère que ce travail sera à la hauteur de vos attentes.
❖ A Monsieur le Professeur Claude KRZISCH
Professeur des Universités -Praticien Hospitalier (Cancérologie, Radiothérapie) OncopôleVous me faites l'honneur de juger ce travail et d'avoir accepté de participer à ce jury de thèse. Mes sincères remerciements pour l'accueil chaleureux et l'enseignement dont j'ai pu bénéficier lors de mon passage dans votre service. Veuillez trouver ici l'expression de ma gratitude et de mon profond respect.
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