OFIDから報告された、心内膜炎チーム。
感想 まとめ
主評価は、チーム設立後のIE死亡率に差がなし。
セカンドは、手術までの時間や入院期間などに差があり。
ごちゃごちゃ言っても、主評価に差がなしのネガティブスタディ。
心臓外科医がチームリーダーなので、手術までの時間が短いのは当たり前だけど良いことですね。
ネガティブスタディですが、良さげな方向性なので、デザインを再考すれば結果はついてきそう。
当院も参考にしたい。
Abstract
Background
Infective endocarditis (IE) remains a severe disease with a high mortality rate. Therefore, guidelines encourage the setup of a multidisciplinary group in reference centers. The present study evaluated the impact of this “Endocarditis Team” (ET).
Methods
We conducted a monocentric observational study at Strasbourg University Hospital, Strasbourg, France, between 2012 and 2017. The primary end point was in-hospital mortality. Secondary end points were 6-month and 1-year mortality, surgery rate, time to surgical procedure, duration of effective antibiotic therapy, length of in-hospital stay, and sequelae. We also assessed predictors of in-hospital mortality.
Results
We analyzed 391 episodes of IE. In the post-ET period, there was a nonsignificant decrease in in-hospital mortality (20.3% vs 14.7%, respectively; P = .27) and sequelae, along with a significant reduction in time to surgery (16.4 vs 10.3 days, respectively; P = .049), duration of antibiotic therapy (55.2 vs 47.2 days, respectively; P < .001), and length of in-hospital stay (40.6 vs 31.9 days, respectively; P < .01). In a multivariate analysis, the post-ET period was positively associated with survival (odds ratio, 0.45; 95% confidence interval, 0.20–0.96; P = .048).
Conclusions
This multidisciplinary approach exerted a positive impact on the management of IE and should be considered in all hospitals managing IE.
