Search

Background: Infective endocarditis (IE) requires multidisciplinary management. We established an endocarditis team within our hospital in 2011 and a state-wide endocarditis network with referring hospitals in 2015. We aimed to investigate their impact on perioperative outcomes. Methods: We retrospectively analyzed data from patients operated on for IE in our center between 01/2007 and 03/2018. To investigate the impact of the endocarditis network on referral latency and pre-operative complications we divided patients into two eras: before (n = 409) and after (n = 221) 01/2015. To investigate the impact of the endocarditis team on post-operative outcomes we conducted multivariate binary logistic regression analyses for the whole population. Kaplan–Meier estimates of 5-year survival were reported. Results: In the second era, after establishing the endocarditis network, the median time from symptoms to referral was halved (7 days (interquartile range: 2–19) vs. 15 days (interquartile range: 6–35)), and pre-operative endocarditis-related complications were reduced, i.e., stroke (14% vs. 27%, p &lt, 0.001), heart failure (45% vs. 69%, p &lt, 0.001), cardiac abscesses (24% vs. 34%, p = 0.018), and acute requirement of hemodialysis (8% vs. 14%, p = 0.026). In both eras, a lack of recommendations from the endocarditis team was an independent predictor for in-hospital mortality (adjusted odds ratio: 2.12, 95% CI: 1.27–3.53, p = 0.004) and post-operative stroke (adjusted odds ratio: 2.23, 95% CI: 1.12–4.39, p = 0.02), and was associated with worse 5-year survival (59% vs. 40%, log-rank &lt, 0.001). Conclusion: The establishment of an endocarditis network led to the earlier referral of patients with fewer pre-operative endocarditis-related complications. Adhering to endocarditis team recommendations was an independent predictor for lower post-operative stroke and in-hospital mortality, and was associated with better 5-year survival.

Das Hepatitis-C-Virus repräsentiert ein bedeutsames Humanpathogen. Beim überwiegenden Anteil HCV-infizierter Patienten entwickelt sich eine persistierende Infektion, welche zur Entwicklung hepatozellulärer Karzinome (HCC) führen kann. Die molekularen Mechanismen, die der HCV-induzierten Kanzerogenese zu Grunde liegen, sind bisher noch unzureichend geklärt. Es ist jedoch bekannt, dass sie mit hepatischer Angiogenese einhergeht. Den wichtigsten Faktor der Angiogenese repräsentiert das VEGF-A. Aus verschiedenen Studien war bekannt, dass eine HCV-Infektion die VEGF-A-Expression beeinflussen kann. So wurde in Vorarbeiten nachgewiesen, dass die Stabilität der VEGF-A-mRNA unter dem Einfluss replizierender HCV-RNA erhöht ist. Im Rahmen der vorliegenden Arbeit wurden die zellulären und viralen Komponenten identifiziert, welche diesen posttranskriptionellen Effekt vermitteln. Dabei konnte nachgewiesen werden, dass die Erkennung der HCV-RNA zur Induktion der zellulären Interferonβ-Immunantwort führt, welche die erhöhte Stabilität der VEGF-A-mRNA induziert., The hepatitis C virus is an important human pathogen. The infection persists in the majority of HCV-infected patients and can lead to the development of hepatocellular carcinomas (HCC). The molecular mechanisms underlying the HCV-induced cancerogenesis are not yet fully understood. However, it is known that it coincides with hepatic angiogenesis. The most important factor of angiogenesis is VEGF-A. Several studies indicate an influence of HCV on the expression of VEGF-A. For example it was shown in former studies, that the VEGF-A-mRNA-stability is increased under the influence of replicating HCV-RNA. In the context of the present study the cellular and viral components mediating this posttranscriptional effect on the VEGF-A-mRNA were identified. Thereby it was demonstrated that the recognition of HCV-RNA leads to the induction of the cellular interferonβ-response, which induces the increased stability of the VEGF-A-mRNA.