ASSESSMENT OF ORGAN DYSFUNCTION IN INFECTIVE ENDOCARDITIS COMPLICATED BY ACUTE HEART FAILURE

Abstract

Listen

Translate article

Resume. Most of the identified risk assessment and prognostic systems for infective endocarditis (IE) focus on surgical risk, and therefore, cannot assess the risk of organ failure in patients receiving medical treatment with multiple comorbidities. To date, there is no standardized prognostic risk scale for organ failure in patients with IE. Objective. Evaluate the dynamics of sepsis-associated organ dysfunction scores in patients with IE complicated by preoperative acute heart failure undergoing cardiopulmonary bypass surgery. Materials and methods. The study included clinical data from 75 patients with IE complicated by preoperative acute heart failure (AHF), who were hospitalized at the State Institution «Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine» from 01.01.2019 to 01.01.2023. The diagnosis of IE was made according to the Duke criteria. All patients were classified as NYHA class IV. At the perioperative stage, clinical and biochemical parameters were assessed, and sepsis-associated organ dysfunction scores were calculated. Results. Based on the clinical parameters obtained, the SOFA score was calculated at the preoperative stage. There were no patients with a score of «0» or «1». At the preoperative stage, all patients exhibited signs of multiorgan dysfunction. The largest cohort consisted of patients with a score of «3» (25 patients with IE). Scores of «4», «5», and «6» were recorded in 18, 12, and 9 patients with IE, respectively. In the presence of HF decompensation and multiorgan failure (SOFA scores of «9», «10», and «11»), 3 patients (4.0 %) with IE died at the preoperative stage. Despite the high risk of postoperative complications, cardiac surgery was performed under cardiopulmonary bypass in 96 % of cases (72 patients). Assessment of patients with IE complicated by preoperative HF on day 2 in the ICU showed an increase in the proportion of patients without signs of multiple organ failure according to the SOFA scale: «0» points - 7 patients, «1» point - 4 patients, «2» points - 22 patients. The proportion of patients with SOFA scores of «3» and «4» was 14 and 12 cases, respectively. The proportion of patients with SOFA scores of «5» and «6» decreased to 5 and 3 patients, respectively. On the second postoperative day, 33 (45.83 %) patients were without signs of multiple organ failure. Conclusions: Effective risk assessment in patients with IE complicated by preoperative HF may play a key role in selecting the optimal time for surgery. The SOFA score can be a useful prognostic tool for assessing the severity of IE.