Predictors of mortality and adverse events in patients with infective endocarditis: a retrospective real world study in a surgical centre

Abstract

Purpose Mortality in infective endocarditis (IE) is still high, and the long term prognosis remains uncertain. This study aimed to identify predictors of long-term mortality for any cause, adverse event rate, relapse rate, valvular and ventricular dysfunction at follow-up, in a real-world surgical centre. Methods We retrospectively analyzed 363 consecutive episodes of IE (123 women, 34%) admitted to our department with a definite diagnosis of non-device-related IE. Median follow-up duration was 2.9 years. Primary endpoints were predictors of mortality, recurrent endocarditis, and major non-fatal adverse events (hospitalization for any cardiovascular cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence), and ventricular and valvular dysfunction at follow-up. Results Multivariate analysis independent predictors of mortality showed age (HR per unit 1.031, p < 0.003), drug abuse (HR 3.5, p < 0.002), EUROSCORE II (HR per unit 1.017, p < 0.0006) and double valve infection (HR 2.3, p < 0.001) to be independent predictors of mortality, while streptococcal infection remained associated with a better prognosis (HR 0.5, p < 0.04). Major non-fatal adverse events were associated with age (HR 1.4, p < 0.022). New episodes of infection were correlated with S aureus infection (HR 4.8, p < 0.001), right-sided endocarditis (HR 7.4, p < 0.001), spondylodiscitis (HR 6.8, p < 0.004) and intravenous drug abuse (HR 10.3, p < 0.001). After multivariate analysis, only drug abuse was an independent predictor of new episodes of endocarditis (HR 8.5, p < 0.001). Echocardiographic follow-up, available in 95 cases, showed a worsening of left ventricular systolic function (p < 0.007); severe valvular dysfunction at follow-up was reported only in 4 patients, all of them had mitral IE (p < 0.03). Conclusions The present study highlights some clinical, readily available factors that can be useful to stratify the prognosis of patients with IE.

Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016–2018)

“…This suggests improvement in rates of surgical procedures especially for patients with complicated IE. Intravenous drug use was strongly associated with complicated IE, and it was an independent predictor of mortality and new episodes of endocarditis, as has been reported previously [13,24].…”

“…One important reason for this could be that such patients seek medical care sooner and hence get earlier treatment, which has been shown to improve complications and mortality [26]. However, previous studies have reported a higher association of mortality with prosthetic valve endocarditis and double valve infection [6,24].…”

“…The length of stay was longer among patients with cardiogenic shock, with a median of 16 days (9, 29) compared to patients with septic shock, 13 days (7,24), and systemic thromboembolism 13 days (7,22). Systemic thromboembolism (IRR 1.25, p \ 0.001), cardiogenic…”

Infective endocarditis in intravenous drug abusers: clinical challenges emerging from a single-centre experience

“…However, as previously reported [ 10 ], drug abusers had a more than doubled long-term risk of death at multivariate analysis (HR 2.3, 95%CI 1.1–4.7, p = 0.015), adjusting for age (HR per unit 1.034, 95%CI 1.018–1.050, p < 0.001), EuroSCORE II (HR per unit 1.015, 95%CI 1.008–1.023, p < 0.001), double-valve infection (HR 2.0, 95%CI 1.4–3.0, p < 0.001), and Streptococcus infection (HR 0.5, 95%CI 0.3–0.8, p = 0.009), which were the variable retained in the final model.…”

Spontaneous spondylodiscitis and endocarditis: interdisciplinary experience from a tertiary institutional case series and proposal of a treatment algorithm

“…Age and gender distribution in our collective was similar to those of other large spondylodiscitis [ 10 ] and endocarditis [ 6 ] collectives. Patients with IE showed typical distributions of affected valves [ 26 ]. Localization of spondylodiscitis did not differ between the S and SIE groups and coincide with literature findings [ 19 ].…”