Early predictors of poor outcome in infectious endocarditis: A Tunisian cohort

Abstract

Despite all improvements in diagnostic imaging modalities and therapeutic regimens, Infective endocarditis remains a lethal disease which is associated with a high mortality rate. The early identification of patients at risk of infective endocarditis complications is essential to improve prognosis. We aimed at identifying the predictive factors at admission for poor outcomes in infective endocarditis patients. This was a prospective study which included all patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Three hundred forty patients were included in this study. The mean age of our patients was 37 ± 17.92 years. There were 56.4% men and 43.6% women. The third of the population had rheumatic heart disease. Cardiac surgery was performed in 76 patients (22.3%), and the overall in-hospital mortality rate was 25%. In the multivariable analysis, the independent predictors of death were: age > 60 years (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.02–1.13), C-reactive protein (CRP) at hospital admission (OR 1.12, 95% CI 1.04–1.21), and the vegetation length on diagnosis (OR 1.15, 95% CI 1.03–1.28). Also, heart failure, cardiogenic shock and embolic events during hospitalization were associated with a poor prognosis. Age, C-reactive protein, and the vegetation size were independent factors associated with and in-hospital mortality. Identifying the predictive factors of mortality in infective endocarditis may improve outcomes.