Predictive value of detected pathogenic bacteria and their inflammatory factors for the prognosis of rheumatic heart disease combined with bacterial endocarditis
OBJECTIVE To investigate the predictive value of detected pathogenic bacteria and their inflammatory factors for the prognosis of rheumatic heart disease combined with bacterial endocarditis.METHODS Totally 85 patients diagnosed with rheumatic heart disease and bacterial endocarditis in the First Affiliated Hospital of Nan-yang Medical College from Jan.2019 to Jan.2021 were selected as the study subjects,and were divided into a poor prognosis group(36 cases)and a no-complication group(49 cases)according to their prognosis.The detected pathogenic bacteria,and lymphocyte(LY),white blood cell count(WBC),the number of neutrophils(NEUT),as well as erythrocyte sedimentation rate(ESR),procalcitonin(PCT),and C-reactive protein(CRP)of patients were analyzed,and the predictive value of individual inflammatory factors for prognosis was evaluated using the receiver operating characteristic(ROC)curve.RESULTS Among the 85 blood culture specimens,70.59％were positive for pathogenicity,and 207 strains of pathogenic bacteria were detected,of which 60 strains of Gram-nega-tive bacteria accounted for 28.99％,and 147 strains of Gram-positive bacteria accounted for 71.01％.The WBC,LY,NEUT,and ESR of patients with blood culture-positive were higher than those of patients with blood cul-ture-negative(P＜0.05).The PCT and CRP levels in patients in the poor prognosis group were higher than those in patients in the no-complication group(P＜0.05).Following up for 3 months,there were 52 patients with low expression of PCT,with an average survival time of(2.56±0.09)months.There were 33 patients with high ex-pression,with an average survival time of(1.09±0.11)months.The chi square value of Logrank analysis for the two groups was 29.476(P＜0.001).There were 58 cases with low CRP expression,with an average survival time of(2.49±0.13)months.There were 27 cases with high CRP expression,with an average survival time of(1.07± 0.12)months.The chi square value of Logrank analysis for two groups was 25.976(P＜0.001).The results of lo-gistic multiple regression analysis showed that surgical treatment was a risk factor affecting the prognosis of pa-tients with rheumatic heart disease combined with bacterial endocarditis(P＜0.05).The AUC of PCT,CRP,and combined diagnosis for the prognosis of rheumatic heart disease combined with bacterial endocarditis were 0.922,0.997,and 0.999,respectively.CONCLUSION Gram-positive bacteria were the main pathogenic bacteria of rheu-matic heart disease combined with bacterial endocarditis,and Streptococcus were the most common.WBC,LY,NEUT,ESR of blood culture-positive patients were higher than those of blood culture-negative patients.The ser-um CRP and PCT of patients in the poor prognosis group were significantly higher than those of patients in the no-complication groups,and the accuracy of combined diagnosis of PCT and CRP was higher,which could be used as a biological indicator for the diagnosis of poor prognosis of rheumatic heart disease combined with bacterial endo-carditis.
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