1990. Prognostic factors for long-term mortality in left-sided infective endocarditis after surgical treatment

Abstract

Background Infective endocarditis is not a prevalent disease but has a high mortality rate. Especially left-sided infective endocarditis (LSIE) shows a higher mortality rate than right-sided infective endocarditis. Surgical treatment is occasionally considered for LSIE, but not much data is available on the long-term prognostic factors for LSIE after surgical treatment. This study investigated the risk factors for long-term mortality in LSIE patients who underwent surgical treatment. Methods This retrospective study enrolled adult patients with LSIE admitted to Severance Hospital in South Korea and underwent surgical treatment from November 2005 to August 2017. The primary outcome was overall all-cause mortality. Multivariate Cox regression analyses were performed to assess the risk factors for long-term mortality of LSIE with surgical treatment. Results 239 cases with LSIE who underwent surgery were enrolled in this study. The median follow-up period was 6.2 years, and there were 34 deaths (14.2%) during the period. The mortality group showed older age (61.0 [53.0-72.0] vs 51.0 [39.0-61.0] years, P = 0.001), more chronic kidney disease (17.6% vs 3.9%, P = 0.007), more chronic liver disease (CLD) (14.7% vs 3.4%, P = 0.017), more cerebral embolisms (58.8% vs 26.8%, P < 0.001), less isolated mitral valve involvement (29.4% vs 52.7%, P = 0.020), and higher Sequential Organ Failure Assessment score (2.0 [1.0-4.0] vs 1.0 [1.0-2.0], P = 0.014). The survivor and mortality groups showed no statistical difference in the time to surgery. Multivariate Cox analyses demonstrated cerebral embolism (Hazard ratio (HR): 3.62, 95% Confidence Interval (CI): 1.79-7.31, P < 0.001), CLD (HR: 4.24, CI: 1.53-11.76, P = 0.005), and age (HR: 1.03, CI: 1.00-1.06, per 1 year, P = 0.021) as risk factors for overall mortality. Kaplan-Meier survival curve showed significant difference between the patients with and without cerebral embolism (P < 0.001, log-rank). Figure 1.Kaplan-Meier survival curve for overall mortality Conclusion Cerebral embolism, CLD, and older age were associated with the long-term mortality in LSIE patients who underwent surgery. Preventive strategies for cerebral embolism are essential for the improvement in LSIE treatment. Disclosures All Authors: No reported disclosures.