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Left-sided infective endocarditis: analysis of in-hospital and medium-term outcome and predictors of mortality
Advisor(s)
Abstract(s)
Abstract
Introduction: Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains
a challenging and potentially lethal disease. The prognosis of IE remains poor; in the last
30 years, its incidence and mortality have only been marginally reduced. Early identification of
high-risk patients can change the course of the disease and improve outcomes.
Objectives and methods: To describe and investigate predictors of mortality during hospital
stay and in the six months after discharge in a cohort of left-sided IE patients in two tertiary
centers. All patients diagnosed with IE (ICD9 code 133) were registered in a uniform database.
Results: One hundred and forty-seven consecutive case patients with left-sided IE were included
in this study. Thirty-five patients (23.8%) died during hospital stay. The variables significantly
associated with increased mortality in univariate analysis were Charlson index
≥5, use of immunosuppressants,
sepsis (severe sepsis and/or septic shock), cardiogenic shock and inappropriate
use of antibiotic therapy. Conversely, surgical therapy and hospital length of stay
≥30 days were
significantly associated with lower mortality. In multivariate analysis the most important predictors
of in-hospital mortality were sepsis (severe and/or shock), use of immunosuppressants
and inappropriate use of antibiotic therapy. There was a significant relation between the use
of immunosuppressants and the occurrence of sepsis. The presence of significant valve disease
after IE significantly increased the risk of heart failure.
Conclusions: Our results may help to identify IE patients at increased risk for in-hospital mortality
and medium-term disability. These findings can help to identify candidates for earlier and
more aggressive management.
Description
Keywords
Infective endocarditis Outcome Analysis Mortality
Citation
Publisher
Elsevier