New Insights into Mortality-Related Risk Factors in Infective Endocarditis: Results from the Brandenburg State Endocarditis Register

Abstract

Objective: Endocarditis as a potentially life-threatening disease with high complication and mortality rates. In recent years, an increase has been reported throughout Europe. In the aging society, successful treatment is complex and challenging owing to the high rate of multimorbidity. Methods: We initiated a statewide prospective multicenter endocarditis registry in 2020. Perioperative risk factors, comorbidities, microbiological, laboratory and imaging diagnostics, complications and mortality including 1-year follow-up were collected. The present midterm analysis includes factors influencing mortality in the first 313 patients. Result: In-hospital mortality and 1-year mortality were 28.4% and 40.9%, respectively. Preoperative risk factors such as age p<0.001, EuroSCORE II p<0.001, Coronary artery disease p=0.022, pacemaker probe infection p=0.033, preoperative LVEF, SIRS, pulmonary edema, heart failure, septic emboli, acute renal failure, impaired coagulation, hypalbuminemia (p<0.001, respectively), NTproBNP p=0.001. Presence of perianular abscess, perforation and shunt were associated with increased mortality (p=0.004, p=0.001, p=0.004, respectively). In addition, Cardiopulmonary bypass time influenced mortality (p=0.002). Main postoperative causes of death were multi-organ failure, renal failure, vasoplegia and low-output syndrome (p<0.001, respectively). Previous endocarditis was 7.7%. 35.5% were prosthetic valve recipients. 33.6% were Redo surgery. Conclusions: Our first Registry data show the complexity of endocarditis patients and the challenging treatment. Some risk factors can be treated preoperatively. For instance, hypalbuminemia and the duration of the procedure which can be controlled with adequate albumin substitution and carefully planned procedures restricted to the essential requirements, i.e. hybrid approaches with consecutive interventions.