| Abstract | Pandemija bolesti COVID – 19 imala je velik utjecaj na globalno zdravlje postavljajući značajne izazove zdravstvenim sustavima širom svijeta. Infektivni endokarditis je ozbiljna infekcija koja zahvaća unutarnju ovojnicu srčanih klijetki i zalistaka. Obično je uzrokovana bakterijama ili gljivama, dok u kontekstu infekcije virusom SARS – CoV – 2 može nastati zbog izravne invazije virusa ili kao posljedica nereguliranog imunološkog odgovora ili uz izostanak postojećih čimbenika rizika. Infektivni endokarditis manifestira se širokim rasponom simptoma koji su često nalik na simptome uslijed bolesti COVID – 19, a oni uključuju stalnu vrućicu, zimicu, umor, bolove u mišićima i zglobovima, otežano disanje.
Istraživanje je planirano kao opservacijska studija koja će uključiti sve punoljetne bolesnike s dijagnozom dokazanog endokarditisa i virusom SARS – CoV – 2 infekcije u razdoblju od 1. siječnja 2018. do 1. ožujka 2023. godine na Klinici za bolesti srca i krvnih žila, Kliničkog bolničkog centra Zagreb. Glavni cilj istraživanja je bio istražiti i usporediti pojavnost endokarditisa u razdobljima prije i tijekom pandemije bolesti COVID – 19, dok je specifični cilj bio usporediti kliničke značajke i čimbenike rizika te usporediti postoji li statistički značajna razlika ili pozitivna korelacija u pojavnosti endokarditisa i osoba inficiranih virusom SARS – CoV – 2 uz ili bez prisutnost različitih komorbiditeta.
U istraživanje je bilo uključeno 93 bolesnika, od kojih je 24 (25,8 %) bilo prije pandemije bolesti COVID – 19, a tijekom pandemije bolesti COVID – 19 bilo je 69 bolesnika (74,2 %). Najčešći uzročnik u oba razdoblja bio je iz roda Staphylococcus. Svi bolesnici liječili su se antibiotskom terapijom, dok je za vrijeme pandemije bolesti COVID – 19 uz antibiotsko liječenje, njih 26,4 % zahtijevalo žurno kardiokirurško liječenje, smrtnih ishoda prije razdoblja pandemije nije bilo, a za vrijeme pandemije bilo 7 smrtnih ishoda (10,6 %). Svi bolesnici imali su opće simptome bolesti, prije razdoblja pandemije bolesti COVID – 19 5,4 % bolesnika imalo je neke od embolijskih incidenata te njih 34,4 % kardiovaskularne simptome, dok je za vrijeme pandemije bolesti COVID – 19, uz opće simptome bolesti, njih 37,5 % najviše imalo kardiovaskularne simptome. Najčešći komorbiditeti u oba razdoblja bili su kardiološke bolesti. Iako je više pacijenata oboljelo od endokarditisa tijekom razdoblja pandemije bolesti COVID – 19, istraživanje nije pokazalo kako su bolesnici tijekom razdoblja pandemije preboljeli i bolest COVID – 19.
Bolest COVID – 19 i endokarditis povezani su samim mehanizmom virusa bolesti COVID – 19 radi svoje prirode djelovanja. Uzrokujući snažnu upalnu reakciju, zahvaćeni organizam dovodi do sistemske upale i moguće citokinske oluje koja kao posljedica može oštetiti krvožilni endotel te time dovesti do disfunkcije endokarda. Također, bolest COVID – 19 uzrokuju koagulopatiju koja može biti predispozicija nastanku endokarditisa radi stvaranja tromba na srčanim zaliscima koji uz upalu prethode nastankom vegetacija na zaliscima. Radi sličnosti simptoma bolesti COVID – 19 i endokarditisa, često je moguća odgoda dijagnoze endokarditisa koja za posljedicu dovodi do niza komplikacija koje su povezane s težim slučajima endokarditisa i samog liječenja te ishoda bolesti što zahtjeva uspostavu uključivanja multidisciplinarnog tima u liječenje. |
| Abstract (english) | The COVID – 19 pandemic has had a major impact on global health, posing significant challenges to healthcare systems around the world. Infective endocarditis is a serious infection that affects the lining of the heart's ventricles and valves. It is usually caused by bacteria or fungi, while in the context of infection with the SARS – CoV – 2 virus, it can occur due to direct invasion of the virus or as a result of an unregulated immune response or in the absence of existing risk factors. Infective endocarditis is manifested by wide range of symptoms that are often similar to symptoms due to the disease COVID – 19, and they include constant fever, chills, fatigue, pain in muscles and joints, difficulty breathing.
The research is planned as a observational study that will include all adult patients with a diagnosis of proven endocarditis and/or with SARS – CoV – 2 virus coinfection in the period from January 1., 2018. to March 1., 2023. at the Clinic for Heart and blood vessel diseases, Clinical Hospital Center Zagreb. The main goal of the research was to investigate and compare the incidence of endocarditis in the periods before and during the global pandemic of COVID – 19, while the specific goal was to compare clinical features and risk factors and to compare whether there is a statistically significant difference or positive correlation in the incidence of endocarditis and people infected with the SARS – CoV – 2 virus with or without the presence of various comorbidities.
In the study, 93 patients were included, of which 24 (25,8 %) were before the pandemic of COVID – 19 disease, and 69 patients (74,2 %) were during the pandemic. The most common causative agent in both periods was from the genus Staphylococcus. All patients were treated with antibiotic therapy, while during the pandemic, in addition to antibiotic treatment, due to complications of endocarditis, 26,4 % of them required urgent cardiosurgical treatment, there were no deaths before the pandemic period, and during the pandemic there were 7 fatal outcomes (10,6 %). All patients had general symptoms of the disease, before the period of the pandemic, 5,4 % of patients had some embolic incidents, and 34,4 % of them had cardiovascular symptoms, while during the COVID – 19 pandemic, in addition to the general symptoms of the disease, 37,5 % of them mostly had cardiovascular symptoms. The most common comorbidities in both periods were cardiac disease. Although more patients fell ill with endocarditis during the period of the COVID – 19 pandemic, the research did not show how the patients also recovered from the disease during the pandemic.
The disease COVID – 19 and endocarditis are linked by the very mechanism of the disease virus of COVID – 19 due to its nature of action. Causing a strong inflammatory reaction, the affected organism leads to systemic inflammation and a possible cytokine storm, which as a consequence can damage the vascular endothelium and thus lead to endocardial dysfunction. Also, the disease COVID – 19 causes coagulopathy, which can be a predisposition to the occurrence of endocarditis due to the formation of thrombus on the heart valves, which, along with inflammation precedes the appearance of vegetations on the valves. Due to the similarity of the symptoms of the disease COVID – 19 and endocarditis, it is often possible to delay the diagnosis of endocarditis, which as a result leads to a series of complications that are associated with more severe cases of endocarditis and the treatment itself and the outcome of the disease which requires the establishment of the involvement of a multidisciplinary team in the treatment. |
