Characteristics, risk factors and outcomes of patients managed for left-sided infective endocarditis: a prospective study in a high-volume center

Abstract

Abstract Background Although medical and surgical management of infective endocarditis (IE) have improved in the recent decades, the associated mortality remains high. Available prospective data are scarce, and further knowledge from prospective cohorts could help improving the prognosis of patients with IE. Objective To describe the characteristics and outcomes of left-sided IE and to determine the risk factors associated to in-hospital mortality in a high-volume center. Methods From 15 September 2020 to 15 February 2023, all patients with left-sided IE managed in a tertiary center of cardiology were included in this prospective, observational study. The diagnosis of IE was made according to current guidelines and management was collegially discussed by the endocarditis team. Determinants of in-hospital death were assessed using a multivariate logistic regression model including any covariate associated in univariate analysis (p<0.1). Results A total of 185 patients were included during the study period. Median age was 68 [56 – 76] years, 141 (76%) patients were males, and 75 (41%) cases involved a prosthetic valve. Aortic valve, mitral valve and involvement of both valves were observed in 111 (60%), 48 (26%) and 26 (14%) patients, respectively. Multimodal cardiac imaging, including cardiac computed tomography (CT) and/or PET-FDG, was used in 64 (35%) of all cases, and 49/75 (65%) patients with valvular prosthesis. Severe valvular regurgitation was identified in 56 (30%) patients, root abscess and/or false aneurysms in 57 (31%) patients. A pathogen agent was identified in 169 (91%) patients, and the most frequent germs were Staphylococcus (30%), Streptococcus (30%) and Enterococcus (17%). A severe initial presentation requiring intensive care unit (ICU) admission was observed in 42 (23%) patients. Cardiac surgery was performed in 102 (55%) cases, and 41 (22%) patients required an emergent surgery. A total of 37 (20%) patients died during the initial in-hospital phase, mostly from cardiac or neurovascular causes. In a multivariate analysis, hypertension (Odd ratio (OR) = 3.3; 95% confidence interval (CI): 1.4 – 10), bi-valvular endocarditis (OR = 3.1; 95%CI: 1.0 – 9.5), unidentified pathogen (OR = 4.3; 95%CI: 1.7 – 15) and chronic alcoholic abuse (OR = 16.4; 95%CI: 3.7 – 87.9) were independently associated with increased in-hospital mortality (Table). Conclusion Severe initial presentation requiring an ICU admission and/or urgent cardiac surgery was common among patients with left-sided IE. Chronic alcoholic abuse and unidentified pathogen appear as major determinants of in-hospital mortality.Table