The etiological agent of IE was revealed in venous blood by bacteriological examination in 52.8% of the examinees, by PCR in 64.2%, and by either in 71.7%. There were concordant and discordant results in 67.9 and 32.1% of the patients, respectively; among whom 18.9% were found to have pathogen DNA revealed by PCR in culture-negative IE.
Aim: to investigate clinical properties of course and outcomes of infective endocarditis (IE) depending on source of infection, to find predictors of mortality in a Moscow general hospital.Materials and methods. We included in this study 176 patients with definite and possible infective endocarditis (the Duke criteria), admitted in our hospital in 2010–2017. Patients were divided in three groups according to source of infection. All patients underwent standard clinical and laboratory assessment, echocardiography, blood culture test combined with blood PCR with sequencing. Inhospital and 1year outcome were evaluated.Results. Among 176 patients with IE 65.3 % were men (median age 57 [35–72] years), most patients (n=149, 84.7 %) had native valve IE. Etiological factor was identified in 127 (72.2 %) cases. Grampositive infective agents prevailed (54 %). Surgery in active phase of the disease was performed in 30 (17 %) patients. Among patients with healthcareassociated IE (n=76, 43.9 %) prevailed those older than 60 years, with high Charlson comorbidity index, with culturenegative IE, and complicated clinical course (mainly progressing heart failure). Patients with intravenous drug use associated IE (n=50, 28.4 %) had low Charlson index, association with hepatitis C viral infection, involvement of tricuspid valve with big vegetations, high frequency of embolic complications, and low inhospital mortality. Group of patients with community acquired IE (n=50, 28.4 %) more often had uncommon causative microorganisms, and had better longterm outcome. Inhospital mortality was 30.1 % (n=53) mostly due to sepsis with multiorgan failure, and heart failure. Risk factors of inhospital death were history of cardiovascular diseases, old age, kidney damage, methicillinresistant Staphylococcus aureus (MRSA) infection, uncontrolled infection, and embolic events. Risk factors of 1year mortality were history of stroke, and heart failure as IE complication. Independent predictors of inhospital death were MRSA infection (odds ratio [OR] 50.32, 95 % confidence interval [CI] 1.66–213.92; p=0.002), persistent infection (OR 18.6, 95 %CI 5.37–64.40; p=0.001), duration of fever >7 days after initiation of antibacterial therapy (OR 13.41, 95 %CI 3.51–51.24; p=0.001); and of death during first year – history of cerebral infarction (OR 4.39, 95 %CI 1.32–14.70; p=0.016)), and heart failure as IE complication (OR 8.1, 95 %CI 1.97–67.09; p=0.016). Among patients subjected to surgery there were no fatal outcomes during 1 year after hospital discharge, while among conservatively treated patients were 21 (14.4 %) deaths (p<0.009).Conclusion. Main clinical features of IE course in patients urgently admitted to a general hospital was dominance of healthcareassociated IE among patients, who were older than 60 years with severe comorbidities. These patients had more complications and worse outcome. Modeling of prognosis identified uncontrolled infection as key factor of unfavorable outcome. Surgery significantly reduced longterm mortality.
Objective:To evaluate the frequency of various profiles in patients, ospitalised with acute decompensated heart failure.Design and method:351 patients (72% males, mean age 66 (58; 76) years old) with ADHF were included. Coronary artery disease had 60%, arterial hypertension 94%, diabetes mellitus 40%, obesity-61%, cardiomyopathy-5%, rheumatic heart disease-4%. HFpEF was found in 31% of patients, HFmrEF – in 25%, HFrEF – in 44%. All patients were distributed according to the following phenotypes: 1 - low blood pressure (<90 mm Hg) and high heart rate (>90 bpm); 2 - low blood pressure (<90 mm Hg) and low heart rate (<60 bpm); 3 - paients with low blood pressure (<90 mm Hg) and normal heart rate (60–90 bpm); 4 - normal blood pressure (>90 mm Hg) and high heart rate (>90 bpm); 5 - normal blood pressure (>90 mm Hg) and low heart rate (<60 bpm); 6 - normal blood pressure (>90 mm Hg) and normal heart rate (60–90 bpm); 7 - atrial fibrillation and normal blood pressure (>90 mm Hg), 8- atrial fibrillation and low blood pressure (<90 mm Hg), 9 - high blood pressure (>140/90 mm Hg); 10 - chronic kidney disease (eGFR <60 ml/min/1,72).Results:The frequency of profile in patients, ospitalised with acute decompensated heart failure were the following: patients with low blood pressure and high heart rate - 0,85%; low blood pressure and low heart rate - 0,56%; patients with low blood pressure and normal heart rate - 1,13%; patients with normal blood pressure and high heart rate - 24,78%; normal blood pressure and low heart rate - 3,13%; patients with normal blood pressure and normal heart rate - 37,03%; patients with atrial fibrillation and normal blood pressure - 42,16%; atrial fibrillation and low blood pressure - 0,85%; high blood pressure - 22,22%; patients with chronic kidney disease - 65,81%.Conclusions:The most common profile in patients ospitalised with acute decompensated heart failure were patients with chronic kidney disease (65,81%), normal blood pressure (64,94%), atrial fibrillation (59,24%), normal blood pressure and normal heart rate (37,03%), high blood pressure (22,22%).
Advances in the diagnosis and treatment of patients with infectious endocarditis are limited by the high frequency of cases with an unknown etiology and imperfection of microbiological (cultural) methods. To overcome these problems new approaches to the identification of infectious endocarditis pathogens were introduced, which allowed achieving certain positive results. However, it should be noted that despite the wide variety of diagnostic tools currently used, there is no ideal method for etiological laboratory diagnosis of infectious endocarditis. The article discusses the features and place of immunochemical, molecular biological (MALDI-TOF MS, real-time PCR, sequencing, in situ fluorescence hybridization, metagenomic methods, etc.), immunohistochemical methods, and their advantages and limitations.
Background: Lung ultrasound (LUS) is a bedside imaging tool that has proven useful in identifying and assessing the severity of pulmonary pathology. The aim of this study was to determine LUS patterns, their clinical significance, and how they compare to CT findings in hospitalized patients with coronavirus infection.Methods: This observational study included 62 patients (33 men, age 59.3±15.9 years), hospitalized with pneumonia due to COVID-19, who underwent chest CT and bedside LUS on the day of admission. The CT images were analyzed by chest radiographers who calculated a CT visual score based on the expansion and distribution of ground-glass opacities and consolidations. The LUS score was calculated according to the presence, distribution, and severity of anomalies.Results: All patients had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 8.1±2.9%. LUS identified 4 different abnormalities, with bilateral distribution (mean LUS score: 26.4±6.7), focal areas of non-confluent B lines, diffuse confluent B lines, small sub-pleural micro consolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (rho = 0.70; p<0.001). Correlation analysis of the CT and LUS severity scores showed good interclass correlation (ICC) (ICC =0.71; 95% confidence interval (CI): 0.52–0.83; p<0.001). Logistic regression was used to determine the cut-off value of ≥27 (area under the curve: 0.97; 95% CI: 90-99; sensitivity 88.5% and specificity 97%) of the LUS severity score that represented severe and critical pulmonary involvement on chest CT (CT: 3-4).Conclusion: When combined with clinical data, LUS can provide a potent diagnostic aid in patients with suspected COVID-19 pneumonia, reflecting CT findings.
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