{"id":1993,"date":"2015-10-01T01:00:00","date_gmt":"2015-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/la-cirrhose-est-un-facteur-independant-de-mortalite-en-cas-dendocardite-bacterienne-resultats-dune-etude-multicentrique-cas-temoins-a-partir-de-202-observations\/"},"modified":"2018-10-20T18:40:12","modified_gmt":"2018-10-20T16:40:12","slug":"la-cirrhose-est-un-facteur-independant-de-mortalite-en-cas-dendocardite-bacterienne-resultats-dune-etude-multicentrique-cas-temoins-a-partir-de-202-observations","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/la-cirrhose-est-un-facteur-independant-de-mortalite-en-cas-dendocardite-bacterienne-resultats-dune-etude-multicentrique-cas-temoins-a-partir-de-202-observations\/","title":{"rendered":"La cirrhose est un facteur ind\u00e9pendant de mortalit\u00e9 en cas d’endocardite bact\u00e9rienne: r\u00e9sultats d’une \u00e9tude multicentrique cas-t\u00e9moins \u00e0 partir de 202 observations."},"content":{"rendered":"

2015<\/strong><\/p>\n

J.-F. Cadranel – Angh (1), I. Ollivier-Hourmand (2), C. Bureau (3), S. Zerkly (1), T. Th\u00e9venot (4), A. Garioud (5), P. Cacoub (5), G. Macaigne (6), L. Alric (3), V. Jouannaud (7), H. Lison (1), C. Chagneau-Derrode (8), E.-A. Pariente (9),
\nA. P\u00e9laquier (10), M. Bourli\u00e8re (11), X. Causse (12), J.-B. Nousbaum (13), J. Dumortier (14), A. Louvet (15), I. Rosa-H\u00e9zode (16), N. Ganne-Carri\u00e9 (17),
\nJ. Gournay (18), T. Antonini (19), L. Spahr (20), T. Dao (2)<\/p>\n

(1) Creil; (2) Caen; (3) Toulouse; (4) Besan\u00e7on; (5) Paris; (6) Lagny-sur-Marne; (7) Montfermeil; (8) Poitiers; (9) Pau; (10) Mont\u00e9limar; (11) Marseille; (12) Orl\u00e9ans; (13) Brest; (14) Lyon; (15) Lille; (16) Cr\u00e9teil; (17) Bondy; (18) Nantes; (19) Villejuif; (20) Gen\u00e8ve, SUISSE.<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02015-04-28 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction
\nUne \u00e9tude r\u00e9cente non contr\u00f4l\u00e9e a montr\u00e9 que l’endocardite bact\u00e9rienne (EB) \u00e9tait une complication grave chez les patients (pts) cirrhotiques (C) [1]. Le but de cette \u00e9tude multicentrique cas-t\u00e9moins \u00e9tait de comparer les caract\u00e9ristiques cliniques et d’analyser les facteurs associ\u00e9s \u00e0 la mortalit\u00e9 de l’EB chez des pts C par rapport \u00e0 des t\u00e9moins (T) appari\u00e9s. <\/p>\n

Patients et M\u00e9thodes
\nLes observations de toutes les EB vues entre 2000 et 2013 chez des pts C par 23 services d’H\u00e9pato-Gastroent\u00e9rologie ont \u00e9t\u00e9 r\u00e9pertori\u00e9es. Chaque patient C a \u00e9t\u00e9 appari\u00e9 \u00e0 un patient T pour l’\u00e2ge, le sexe et l’existence d’un diab\u00e8te. Les caract\u00e9ristiques cliniques, bact\u00e9riologiques, th\u00e9rapeutiques et la mortalit\u00e9 de l’EB ont \u00e9t\u00e9 collig\u00e9es. Les r\u00e9sultats sont exprimes en m\u00b1sd. Les facteurs associ\u00e9s \u00e0 la mortalit\u00e9 ont \u00e9t\u00e9 \u00e9tudies en analyse univari\u00e9e et multivari\u00e9e (r\u00e9gression logistique). <\/p>\n

R\u00e9sultats
\n101 cas d’EB chez des pts C et 101 EB chez des pts T ont \u00e9t\u00e9 analys\u00e9s. C : 63,3 [42-87] ans ; T : 65 [46-93] ans ; 145 H (72%). La cirrhose \u00e9tait alcoolique : 78 (67,2%), virale : 17 (14,6%), m\u00e9tabolique : 14 (12%). Lors du diagnostic d’EB, 79,6% des pts C et 87,9% des pts T \u00e9taient f\u00e9briles. 82,2% des pts C et 66,6% des pts T avaient un souffle cardiaque. Le score de Child-Pugh \u00e9tait : A : 8,8% pts, B : 42,9% pts, C : 48,4% pts. Chez les pts cirrhotiques, la bilirubin\u00e9mie totale \u00e9tait \u00e0 67,8μmol\/l\u00b177,7 (>100 μmol\/l : 18% pts), le TP \u00e0 52,7%\u00b118,1 (TP<40% : 29% pts), l'albumin\u00e9mie \u00e0 25g\/l\u00b15,9 et la cr\u00e9atinin\u00e9mie \u00e0 123,5μmol\/l\u00b1103,6 (109,8μmol\/l+\/-66,3 chez pts T). Les h\u00e9mocultures \u00e9taient positives chez 181 pts (92%). 39 pts C (40,2%) et 52 pts T (53,6%) avaient une cardiopathie pr\u00e9existant \u00e0 l'EB. Au moment du diagnostic d'EB, 43 pts C (47,7%) et 31 pts T (34,0%) avaient une insuffisance cardiaque. Un sepsis s\u00e9v\u00e8re ou un choc septique \u00e9tait not\u00e9 chez 33 pts C (33,3%) et 23 pts T (23,0%). La porte d'entr\u00e9e de l'endocardite \u00e9tait digestive-cutan\u00e9e-urinaire chez 41 pts C et 21 pts T. Les autres portes d'entr\u00e9e avaient une fr\u00e9quence similaire. La valve aortique \u00e9tait atteinte chez 68,4% des pts C et 47,7% des pts T ; une atteinte bivalvulaire \u00e9tait not\u00e9e respectivement chez 23,4% et 10,3% des pts C et T. Les germes isol\u00e9s (staphylocoque n=67: C=33, T=34; streptocoque n=92: C=48, T = 44) \u00e9taient comparables de m\u00eame que les antibiotiques utilis\u00e9s et la dur\u00e9e du traitement : pts C : 40,6j\u00b128 et pts T : 39,2j\u00b122,5. 26 pts C (27,1%) et 44 pts T (44,9%) ont eu une chirurgie cardiaque. 56 (62,2%) des pts C et 25 (27,8%) des pts T sont d\u00e9c\u00e9d\u00e9s. En analyse univari\u00e9e sur l'ensemble de la population, le d\u00e9c\u00e8s \u00e9tait li\u00e9 \u00e0 l'existence d'une cirrhose OR 4,4 [2,1-9,1] (p<0,0001), \u00e0 la cr\u00e9atinin\u00e9mie (p = 0,003), \u00e0 un sepsis s\u00e9v\u00e8re ou un choc OR 2,3 [1,1-5] (p<0,02) et \u00e0 un TP<40% OR 6,3 [2,2 -18,8] (p<0,0001). Chez les pts C, la mortalit\u00e9 \u00e9tait li\u00e9e \u00e0 un TP<40% OR 6,75 [1,6-32,7] (p = 0,002), \u00e0 la cr\u00e9atinin\u00e9mie (p<0,03) et \u00e0 l'existence d'une ascite OR 7,4 [1,7-34,2] (p = 0,001). La mortalit\u00e9 en analyse multivari\u00e9e \u00e9tait li\u00e9e dans la population globale \u00e0 l'existence d'une cirrhose OR 2,35 [1,04- 5,36] (p = 0,04) et d'un TP<40% OR 7,52 [2,41-29,26] (p<0,001) et dans la population C \u00e0 un TP<40% OR 23,3 [3,1-574] (p = 0,01) et \u00e0 l'existence d'une ascite OR 7,6 [1,34-59] (p = 0,03). <\/p>\n

Conclusion
\nL'EB est tr\u00e8s s\u00e9v\u00e8re chez les patients cirrhotiques qui ont moins souvent acc\u00e8s \u00e0 la chirurgie cardiaque. La cirrhose est un facteur ind\u00e9pendant de mortalit\u00e9 avec un risque de d\u00e9c\u00e8s 2,35 fois plus \u00e9lev\u00e9 chez les patients ayant une EB. En cas de cirrhose, les facteurs pr\u00e9dictifs de d\u00e9c\u00e8s sont un TP<40% qui multiplie le risque de d\u00e9c\u00e8s par 23,3 et l'existence d'une ascite qui le multiplie par 7,6. <\/p>\n

R\u00e9f\u00e9rences
\n1) Cadranel JF, et al. Pr\u00e9sentation clinique et pronostic des endocardites bact\u00e9riennes chez les patients atteints de cirrhose : R\u00e9sultats d'une s\u00e9rie multicentrique de 78 observations. CO 131 – JFHOD 2014.<\/p>\n","protected":false},"excerpt":{"rendered":"

2015 J.-F. Cadranel – Angh (1), I. Ollivier-Hourmand (2), C. Bureau (3), S. Zerkly (1), T. Th\u00e9venot (4), A. Garioud (5), P. Cacoub (5), G. Macaigne (6), L. Alric (3), V. Jouannaud (7), H. Lison (1), C. Chagneau-Derrode (8), E.-A. Pariente (9), A. P\u00e9laquier (10), M. Bourli\u00e8re (11), X. Causse (12), J.-B. Nousbaum (13), J. 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