Clinical characteristics and prognosis of patients with infective endocarditis admitted to a coronary unit in a hospital with cardiac surgery

Abstract

Abstract Funding Acknowledgements None. Introduction Cardiac critical care units are essential for the management of complicated infective endocarditis (IE). Objective We set out to analyze the baseline characteristics, clinical complications and prognosis of patients with IE admitted to a Coronary Care Unit (CCU), as well as to compare them with patients admitted to hospital wards. Material and Methods Prospective, single-centre, observational study including patients who were diagnosed of IE from 2016-2022 and admitted in a hospital with cardiac surgery. They were classified into two groups according to whether or not they were admitted to the CCU. We collected data on microbiological isolation, cardiac and systemic complications as well as in-hospital mortality. Patients were followed long-term for cardiovascular (CV) and all-cause mortality, readmission and IE recurrence. All variables (qualitative) were compared by Chi-square test and overall mortality was compared in both groups by the LogRank test. We established a significance level of p<0.05. Results From a total of 162 patients with a median age of 68 years (IQR 68), 28.4% (46) were admitted to the CCU. These patients were similar in age to those not admitted (mean 65 vs 66 years, NS), but had a higher percentage of diabetics (47.8 vs 27.6%, p=0.01). The most frequent previous heart disease in both groups was valvular heart disease. The most frequently isolated microorganisms in CCU patients were Staphylococcus aureus (46.4%) and Streptococcus epidermidis (37.9%) which, in our series, produced the highest percentage of shock (35.7% and 23.3% respectively) in a statistically significant way (p<0.01), with the need for noradrenaline (60.9%) and dobutamine (28.3%); no ventricular assist devices were used. Critically ill patients had a higher incidence of atrioventricular block requiring a permanent pacemaker (32.6% vs 4.3%, p<0.01), valve dysfunction (76.1% vs 55.2%, p=0.014) and were more frequently operated than those admitted to the ward (56.%% vs 38%, p=0.04). Among all IE patients, 24.6% died during admission, most of them (15.7% of the total) were admitted to the coronary unit (p<0.01). In our 36-month mean follow-up, we found significantly higher readmission rates in the CCU group (36.6% vs. 15%, p<0.01), unrelated to IE recurrences. The critically ill group exhibited a higher mortality rate due to cardiovascular disease and all-cause causes (43.5% vs 15.9%, p0.01; 63% vs 23.9%, p0.01). In the CCU group there is significantly lower survival (mean 65 vs 37 months, LogRank p<0.01) with respect to the hospital ward group. Conclusion Our CCU is responsible for treating patients with IE that is highly complex and that progresses poorly, with a higher frequency of shock and in-hospital mortality, which leads to a decreased prognosis during follow-up. Anticipating complications and collaborating with cardiac surgery is essential to improve clinical outcomes.