Arteritis y seudoaneurisma coronarios en la enfermedad de Behçet: una causa infrecuente de infarto de miocardio / Coronary arteritis and pseudoaneurysm in Behçet’s disease: a rare cause of myocardial infarction

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Mortalidad en pacientes con endocarditis infecciosas atendidos en 2 hospitales dotados de cirugía cardiaca. Réplica / Mortality in patients with infective endocarditis treated in 2 different centers with on-site cardiac surgery. Reply

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Endocarditis infecciosa en 2 hospitales universitarios españoles que difieren en su localización y en la presencia de servicio quirúrgico / Infective endocarditis in two Spanish university hospitals in different geographical locations with and without a cardiac surgery department

OBJETIVOS: Comprobar si existen diferencias en la presentación clínica, microbiología y morbimortalidad intrahospitalaria de la endocarditis infecciosa entre 2 centros españoles, uno peninsular y con cirugía cardiaca y otro en Canarias que debe derivar a los pacientes quirúrgicos. Método Estudio retrospectivo de 229 pacientes con endocarditis, incluidos pediátricos, ingresados de forma consecutiva en los hospitales Reina Sofía de Córdoba (n = 119) y Nuestra Señora de Candelaria, en Tenerife (n = 110), entre 2005 y 2012. Se compararon las variables clínicas, microbiológicas y ecocardiográficas y se analizaron las diferencias de mortalidad mediante un análisis de regresión logística binaria. Resultados No hubo diferencias en la cardiopatía predisponente, en la proporción de casos intervenidos ni en el perfil microbiológico. En el hospital canario la proporción de infecciones por catéter fue mayor (13,6% vs 3,4%), así como la mortalidad global (31,8% vs 18,5%; p = 0,020). Esta diferencia de mortalidad entre hospitales dejó de resultar significativa en el análisis multivariable (OR = 1,85; IC 95%, 0,70-4,87; p = 0,213), siendo la edad (OR por año = 1,04; IC 95%, 1,01-1,07; p = 0,006), las complicaciones cardiacas (OR = 5,05; IC 95%, 1,78-14,34; p = 0,002), la sepsis persistente (OR = 4,89; IC 95%, 2,09-11,46; p < 0,001) y la cirugía emergente (OR = 4,43; IC 95%, 1,75-11,19; p = 0,002) predictores independientes de muerte. El tiempo hasta la cirugía, mayor en el hospital sin servicio quirúrgico (20 [13-30,5] vs 13 [6-25] días; p = 0,019) no se asoció con el desenlace. Conclusiones Existen diferencias en la presentación de la endocarditis entre 2 hospitales españoles distantes. La ausencia de servicio quirúrgico no puede relacionarse directamente con la distinta evolución intrahospitalaria

OBJECTIVES: To assess possible differences in clinical presentation, microbiology, morbidity and mortality of infective endocarditis between two Spanish hospitals, one on the mainland that has cardiac surgery and one in the Canary Islands without this service. METHOD: A total of 229 patients consecutively diagnosed of endocarditis between 2005 and 2012, including pediatric population, were studied in the Reina Sofía Hospital (Córdoba, n = 119) and Nuestra Señora de Candelaria Hospital (Tenerife, n = 110). We compared the clinical, microbiological and echocardiographic data and analyzed mortality differences by binary logistic regression analysis. RESULTS: There were no differences in underlying heart disease, proportion of surgery, or the microbiological profile. The proportion of infections attributable to catheter was higher in the Canary Islands hospital (13.6% vs 3.4%). Mortality was also higher (31.8% vs 18.5%, P=.020), although this difference was no longer significant in the multivariate analysis (OR = 1.85; 95%CI, 0.70-4.87; P = .213). Age (OR = 1.04/year; 95%CI, 1.01-1.07; P=.006), cardiac complications (OR = 5.05; 95%CI, 1.78-14.34; P=.002), persistent sepsis (OR = 4.89; 95%CI, 2.09-11.46; P < .001), and emergent surgery (OR = 4.43, 95%CI, 1.75-11.19; P = .002) were independent predictors of death. Time to surgery, length of stay in the hospital without a surgical service (20 [13-30.5] vs 13 [6-25] days; P = .019) was not associated with outcome. CONCLUSIONS: There are differences in the presentation of endocarditis between two distant hospitals in Spain. The different hospital mortality can not be directly related to the presence of a surgery service

[Infective endocarditis in two Spanish university hospitals in different geographical locations with and without a cardiac surgery department]. / Endocarditis infecciosa en 2 hospitales universitarios españoles que difieren en su localización y en la presencia de servicio quirúrgico.

OBJECTIVES: To assess possible differences in clinical presentation, microbiology, morbidity and mortality of infective endocarditis between two Spanish hospitals, one on the mainland that has cardiac surgery and one in the Canary Islands without this service. METHOD: A total of 229patients consecutively diagnosed of endocarditis between 2005 and 2012, including pediatric population, were studied in the Reina Sofía Hospital (Córdoba, n=119) and Nuestra Señora de Candelaria Hospital (Tenerife, n=110). We compared the clinical, microbiological and echocardiographic data and analyzed mortality differences by binary logistic regression analysis. RESULTS: There were no differences in underlying heart disease, proportion of surgery, or the microbiological profile. The proportion of infections attributable to catheter was higher in the Canary Islands hospital (13.6% vs 3.4%). Mortality was also higher (31.8% vs 18.5%, P=.020), although this difference was no longer significant in the multivariate analysis (OR=1.85; 95%CI, 0.70-4.87; P=.213). Age (OR=1.04/year; 95%CI, 1.01-1.07; P=.006), cardiac complications (OR=5.05; 95%CI, 1.78-14.34; P=.002), persistent sepsis (OR=4.89; 95%CI, 2.09-11.46; P<.001), and emergent surgery (OR=4.43, 95%CI, 1.75-11.19; P=.002) were independent predictors of death. Time to surgery, length of stay in the hospital without a surgical service (20 [13-30.5] vs 13 [6-25] days; P=.019) was not associated with outcome. CONCLUSIONS: There are differences in the presentation of endocarditis between two distant hospitals in Spain. The different hospital mortality can not be directly related to the presence of a surgery service.