{"id":1996,"date":"2014-10-01T01:00:00","date_gmt":"2014-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/presentation-clinique-et-pronostic-des-endocardites-bacteriennes-chez-les-patients-atteints-de-cirrhose-a-partir-dune-serie-multicentrique-de-78-observations\/"},"modified":"2018-10-20T18:40:12","modified_gmt":"2018-10-20T16:40:12","slug":"presentation-clinique-et-pronostic-des-endocardites-bacteriennes-chez-les-patients-atteints-de-cirrhose-a-partir-dune-serie-multicentrique-de-78-observations","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/presentation-clinique-et-pronostic-des-endocardites-bacteriennes-chez-les-patients-atteints-de-cirrhose-a-partir-dune-serie-multicentrique-de-78-observations\/","title":{"rendered":"Pr\u00e9sentation clinique et pronostic des endocardites bact\u00e9riennes chez les patients atteints de cirrhose, \u00e0 partir d\u2019une s\u00e9rie multicentrique de 78 observations."},"content":{"rendered":"

2014<\/strong><\/p>\n

J-F. Cadranel (1), M. Allaire (2), H. Blasco-Perrin (3), T. Th\u00e9venot (4), C. Chagneau-Derrode (5), E.-A. Pariente (6), A. Garioud (7), H. Lison (1), X . Causse (8), X Adhoute (9), J.-B. Nousbaum (10), I. Rosa- Hezode (11), V. Jouannaud (12), T.-M. Antonini (13), J. Denis (14), E. Sarlon (1), G. Le Folgoc (9), I. Ollivier-Hourmand (2), V. Di Martino (4), C. Silvain (5), X Amiot (7), M . Bakkar (8), M. Bourli\u00e8re (9), J.-D. Grange (7),H Hagege (11), B. Lesgourgues (12), C. Bureau (3), T. Dao (2) , ENDOCC group (15) and ANGH (16)
\n(1) Creil; (2) Caen; (3) Toulouse; (4) Besan\u00e7on; (5) Poitiers; (6) Pau; (7) Paris; (8) Orl\u00e9ans; (9) Marseille; (10) Brest; (11) Cr\u00e9teil; (12) Montfermeil; (13) Villejuif; (14) Corbeil-Essonnes, (15) groupe ENDOCC (16 ) ANGH.
\n .-F. Cadranel (1), M. Allaire (2), H. Blasco-Perrin (3), T. Th\u00e9venot (4), C. Chagneau-Derrode (5), E.-A. Pariente (6), A. Garioud (7), H. Lison (1), X . Causse (8), X Adhoute (9), J.-B. Nousbaum (10), I. Rosa- Hezode (11), V. Jouannaud (12), T.-M. Antonini (13), J. Denis (14), E. Sarlon (1), G. Le Folgoc (9), I. Ollivier-Hourmand (2), V. Di Martino (4), C. Silvain (5), X Amiot (7), M . Bakkar (8), M. Bourli\u00e8re (9), J.-D. Grange (7),H Hagege (11), B. Lesgourgues (12), C. Bureau (3), T. Dao (2) , ENDOCC group (15) and ANGH (16)
\n(1) Creil; (2) Caen; (3) Toulouse; (4) Besan\u00e7on; (5) Poitiers; (6) Pau; (7) Paris; (8) Orl\u00e9ans; (9) Marseille; (10) Brest; (11) Cr\u00e9teil; (12) Montfermeil; (13) Villejuif; (14) Corbeil-Essonnes, (15) groupe ENDOCC (16 ) ANGH.<\/p>\n

J.-F. Cadranel (1), M. Allaire (2), H. Blasco-Perrin (3), T. Th\u00e9venot (4), C. Chagneau-Derrode (5), E.-A. Pariente (6), A. Garioud (7), H. Lison (1), X . Causse (8), X Adhoute (9), J.-B. Nousbaum (10), I. Rosa- Hezode (11), V. Jouannaud (12), T.-M. Antonini (13), J. Denis (14), E. Sarlon (1), G. Le Folgoc (9), I. Ollivier-Hourmand (2), V. Di Martino (4), C. Silvain (5), X Amiot (7), M . Bakkar (8), M. Bourli\u00e8re (9), J.-D. Grange (7),H Hagege (11), B. Lesgourgues (12), C. Bureau (3), T. Dao (2) , ENDOCC group (15) and ANGH (16)
\n(1) Creil; (2) Caen; (3) Toulouse; (4) Besan\u00e7on; (5) Poitiers; (6) Pau; (7) Paris; (8) Orl\u00e9ans; (9) Marseille; (10) Brest; (11) Cr\u00e9teil; (12) Montfermeil; (13) Villejuif; (14) Corbeil-Essonnes, (15) ENDOCC group (16 ) ANGH.<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02014-04-18 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Introduction
\nL’endocardite bact\u00e9rienne (EB) est une complication rare mais grave chez les patients cirrhotiques (CIR). Le but de cette \u00e9tude multicentrique est de pr\u00e9senter les caract\u00e9ristiques cliniques et le pronostic de l’EB chez les patients CIR.
\nPatients et M\u00e9thodes
\nLes observations de toutes les EB vues entre 2000 et 2013 chez des patients (pts) CIR par 14 services d’H\u00e9pato-Gastroent\u00e9rologie en France ont \u00e9t\u00e9 r\u00e9pertori\u00e9es. Les caract\u00e9ristiques cliniques, h\u00e9patologiques, cardiologiques, bact\u00e9riologiques, th\u00e9rapeutiques ainsi que l’\u00e9volution ont \u00e9t\u00e9 collig\u00e9es. Les r\u00e9sultats sont exprim\u00e9s en m\u00b1sd. Les facteurs associ\u00e9s \u00e0 la mortalit\u00e9 ont \u00e9t\u00e9 \u00e9tudi\u00e9s en analyse univari\u00e9e et multivari\u00e9e (r\u00e9gression logistique).
\nR\u00e9sultats
\n78 observations d’EB chez 77 pts CIR (\u00e2ge m\u00e9dian : 64 ans [43-89 ans] ; 60 H et 17 F) ont \u00e9t\u00e9 analys\u00e9es. La cirrhose \u00e9tait alcoolique : 59 (76,6%), virale : 11 (14%), m\u00e9tabolique : 3pts (4%), mixte : 3 pts (4%). 34 pts (43,5%) \u00e9taient diab\u00e9tiques, 13 pts avaient eu unecomplication ant\u00e9rieure de la cirrhose. Lors du diagnostic d’EB, 80% et 78% des pts \u00e9taient f\u00e9briles et avaient un souffle cardiaque respectivement. Le score de Child Pugh \u00e9tait : A :7% pts, B : 45% pts, C : 48% pts. La bilirubin\u00e9mie totale \u00e9tait \u00e0 71,6 \u00b1 83,9μmol\/l (> 100 :20% pts), le TP \u00e0 53% \u00b1 17,2 (TP130 : 30% pts). Les h\u00e9mocultures \u00e9taientpositives chez 70 pts (92%). 33 pts avaient une cardiopathie pr\u00e9existant \u00e0 l’EB. Au momentdu diagnostic d’EB, 33 pts (49,2%) avaient une insuffisance cardiaque. La porte d’entr\u00e9e del’endocardite \u00e9tait digestive dans 13 cas, dentaire dans 15 cas, cutan\u00e9e dans 15 cas,iatrog\u00e8ne dans 6 cas. Les valves touch\u00e9es \u00e9taient : mitrale chez 41 pts et aortique chez 50pts, avec insuffisance mitrale et aortique chez respectivement 32 et 30 pts. 19 pts avaient
\nune atteinte bi-valvulaire mitrale et aortique. 10 pts avaient un r\u00e9tr\u00e9cissement valvulaire. Lafraction d’\u00e9jection ventriculaire \u00e9tait de 57% (\u00b1 16). Un germe a \u00e9t\u00e9 isol\u00e9 chez 68 pts
\n(87%) : Staphylocoque pour 28 pts (41%) ; Streptocoque pour 27 pts (40%, dont 7 pts (10%) avec S Bovis), ent\u00e9rocoque ou E Coli chez 9 pts (13%) ; Les pts ontre\u00e7u37 (\u00b120) jours d’antibioth\u00e9rapie. Les antibiotiques les plus souvent utilis\u00e9s \u00e9taient la gentamycine chez43 pts (55,1%), l’amoxicilline chez 41 pts (52,6%), la vancomycine chez 21 pts (26,9%), etla ceftriaxone chez 19 pts (23,4%). 21 pts ont eu une chirurgie cardiaque. 40 pts (51%) sur77 sont d\u00e9c\u00e9d\u00e9s. Le d\u00e9c\u00e8s \u00e9tait li\u00e9 dans 11 cas \u00e0uneinsuffisanceh\u00e9patocellulaireterminale avec syndrome h\u00e9pato-r\u00e9nal, dans 16 cas \u00e0 une d\u00e9faillance multi visc\u00e9rale, dans 4 cas \u00e0 un choc cardiog\u00e9nique, dans 4 cas en rapport avec des abc\u00e8s c\u00e9r\u00e9braux multiples, dans 2 cas li\u00e9 \u00e0 une h\u00e9morragie digestive. En analyse univari\u00e9e, le d\u00e9c\u00e8s n’\u00e9tait pas li\u00e9 \u00e0 l’\u00e2ge, au stade de Child Pugh, \u00e0 la cr\u00e9atinin\u00e9mie, \u00e0 la bilirubine totale ni \u00e0 l’utilisation de gentamycine mais li\u00e9 \u00e0 un TP<40% (p =0.03). Ce r\u00e9sultat persistait en analyse multivari\u00e9e avec un risque de d\u00e9c\u00e8s multipli\u00e9 par 8 pour un TP<40% (OR = 8,3 IC95% [6,6-10] ), apr\u00e8s ajustement sur l'\u00e2ge, le sexe, le fait de pr\u00e9senter une insuffisance cardiaque ou un diab\u00e8te.
\nConclusion :
\nLe pronostic de l'EB chez les CIR, dont la porte d'entr\u00e9e est souvent digestive, est tr\u00e8s s\u00e9v\u00e8re, entra\u00eenant le d\u00e9c\u00e8s dans la moiti\u00e9 des cas ; le risque de d\u00e9c\u00e8s est multipli\u00e9 par 8 chez les patients ayant un TP<40%.<\/p>\n","protected":false},"excerpt":{"rendered":"

2014 J-F. Cadranel (1), M. Allaire (2), H. Blasco-Perrin (3), T. Th\u00e9venot (4), C. Chagneau-Derrode (5), E.-A. Pariente (6), A. Garioud (7), H. Lison (1), X . Causse (8), X Adhoute (9), J.-B. Nousbaum (10), I. Rosa- Hezode (11), V. Jouannaud (12), T.-M. Antonini (13), J. Denis (14), E. Sarlon (1), G. Le Folgoc (9), […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[25],"class_list":["post-1996","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-25"],"yoast_head":"\nPr\u00e9sentation clinique et pronostic des endocardites bact\u00e9riennes chez les patients atteints de cirrhose, \u00e0 partir d\u2019une s\u00e9rie multicentrique de 78 observations. - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/presentation-clinique-et-pronostic-des-endocardites-bacteriennes-chez-les-patients-atteints-de-cirrhose-a-partir-dune-serie-multicentrique-de-78-observations\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pr\u00e9sentation clinique et pronostic des endocardites bact\u00e9riennes chez les patients atteints de cirrhose, \u00e0 partir d\u2019une s\u00e9rie multicentrique de 78 observations. - 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