Clinical features and predictive factors of in-hospital mortality in infective endocarditis

Abstract

Infective endocarditis (IE) is a severe infection with high in-hospital mortality rate. Identification of patients at high risk of death may improve their outcomes. We aim to determine clinical features and predictive factors of intra hospital mortality in patients with IE. Retrospective single-center study including patients with IE admitted during 17 years (1998–2015) in Cardiology B department of Fattouma Bourguiba University Hospital. Diagnosis of IE was made according to the modified Duke classification. A Total of 235 patients were included, 56.3% were male. Mea age was 36 ± 17 years. Forty-three percent of them had previous valvular heart disease. Prosthetic IE occurred in 25.1%. Mitral valve was the most affected by infection. In-hospital mortality rate was 18.3% (43 patients). Dead patients presented significatively more heart failure at admission (53.5% vs. 25.7%, P < 0.001), peripheral embolization (32.6% vs. 5.7%, P = 0.012), major cerebro-vascular events such as hemorrhagic stroke (16.3% vs. 3.7%, P = 0.002), mycotic cerebral aneurysm (14% vs. 4.2%, P = 0.02) and cerebral abcess (7% vs. 0.5%, P = 0.017). In multivaraite analysis, predictive factors of in-hospital death were heart failure at admission (OR = 3.8, 95% CI: 1.8–7.9, P < 0.001), embolic events (OR = 2.28, 95% CI: 1.01–5.2, P = 0.02) and hemorrhagic stroke (OR = 6.06, 95% CI: 1.8–19.5, P = 0.017). IE remains awful disease with high mortality rate. The risk factors of in-hospital death were heart failure, embolic events and hemorrhagic stroke.