关键词: 感染性心内膜炎, 心脏外科手术, ICU时间延长, 危险因素

Abstract:

Objective Analyzing risk factors for prolonged ICU stay after cardiac surgery of Infective Endocarditis （IE） provides a basis for preventing extended ICU durations in postoperative IE cases. Methods From January 1， 2019， to March 31， 2021， a total of 223 patients with infective endocarditis who underwent cardiac surgery in the cardiac surgery department of Guangdong Provincial People's Hospital were included. Patients were divided into non-prolonged group （< 3 days） and prolonged group （≥ 3 days） based on postoperative ICU stay duration. There were 156 cases in the non-prolonged group and 67 cases in the prolonged group. Single-factor analysis of risk factors for prolonged ICU stay was conducted using t-tests or rank-sum tests. Variables with P < 0.05 in the single-factor analysis were further subjected to binary logistic regression for multivariate analysis. The accuracy of the model was evaluated using the ROC curve. Results Among the 223 patients， 67 experienced prolonged ICU stay， with an incidence rate of 30%. Single-factor analysis results included gender， age， history of coronary heart disease， history of stroke， preoperative heart failure， aortic valve regurgitation area， left ventricular end-diastolic diameter， left ventricular ejection fraction （LVEF） <60%， extracorporeal circulation time， aortic cross-clamp time， use of Intra-Aortic Balloon Pump （IABP）， endotracheal tube reintubation， pulmonary infection， use of Continuous Renal Replacement Therapy （CRRT）， and prolonged mechanical ventilation time （> 24 hours）， among others. Multivariate analysis results revealed that preoperative LVEF < 60% （OR = 3.004， P = 0.041）， postoperative use of IABP （OR = 31.686， P = 0.008）， and mechanical ventilation time > 24 hours （OR = 8.135， P < 0.001） were independent risk factors for prolonged ICU stay after cardiac surgery. The model's AUC value for predicting risk factors for prolonged ICU stay was 0.858 （95% CI： 0.806 ~ 0.901， P < 0.001）. Conclusion Preoperative left ventricular ejection fraction （LVEF） < 60%， the use of IABP， and mechanical ventilation time > 24 hours were identified as independent risk factors for prolonged ICU stay after infective endocarditis （IE） surgery. In clinical practice， it is important to comprehensively address and manage various risk factors with the aim of reducing ICU stay duration and improving the overall success rate of the surgery.

Key words: infective endocarditis, cardiac surgery, prolonged ICU Stay, risk factors