Embolic phenomena to the limbs are an independent predictor of in-hospital mortality from infective endocarditis.

Abstract

Infective endocarditis (IE) is a morbid condition with high mortality. We investigated predictors of in-hospital mortality and embolic phenomena in a contemporary Australasian cohort. We identified all patients with IE admitted between January 2017 and 30th April 2020 (40 months). Patient characteristics, risk factors and clinical outcomes were retrospectively collected and analysed. One hundred and seventy-two consecutive patients (mean age: 56.8± 17.9 years, male: 63%, 114/172) were included. Causative organisms were Staphylococcus aureus (44%, 75/172), Enterococcus faecalis (15%, 26/172), Streptococcus mitis (6%, 10/172) and Staphylococcus epidermidis (3%, 6/172). In-hospital mortality was 15% (25/172). Embolic complications were found among 57% (98/172) of patients, the most common being stroke (23%, 40/172), septic pulmonary emboli (17%, 29/172), splenic and/or renal emboli (17%, 26/172) and peripheral limb emboli (15%, 25/172). Sixty (35%, 60/172) patients underwent cardiac surgery. On multivariable analysis, independent predictors of in-hospital mortality were: increased age (odds ratio: 1.064, per year older, P= 0.001), ICU admission independent of cardiac surgery (OR 9.81, P< 0.001), moderate or severe LV impairment (OR 5.19, P= 0.012) and any sign of embolic phenomena to limbs (OR 5.02, P= 0.006). Multivariable predictors of embolic complications were S. aureus bacteraemia (OR 3.22, P= 0.001) and large vegetation >10 mm (OR 3.04, P= 0.002). We demonstrate predictors of in-hospital mortality and embolic phenomena in our cohort. Though age remains a consistent predictor of mortality, surprisingly, signs of embolic phenomena to the limbs was established as an independent predictor of mortality. The mechanism of this is unclear and warrants further evaluation.