Evaluation of Laboratory Predictors for In-Hospital Mortality in Infective Endocarditis and Negative Blood Culture Pattern Characteristics.

Ana-Maria Buburuz,Igor Jelihovschi,Irina Iuliana Costache,Catalina Arsenescu-Georgescu,Luminita Smaranda Iancu,Antoniu Petris

doi:10.3390/pathogens10050551

Abstract

Objective: This study aimed to identify possible differences between blood culture-negative and blood culture-positive groups of infective endocarditis (IE), and explore the associations between biological parameters and in-hospital mortality. Methods: This was a retrospective study of patients hospitalized for IE between 2007 and 2017. Epidemiological, clinical and paraclinical characteristics, by blood culture-negative and positive groups, were collected. The best predictors of in-hospital mortality based on the receiver-operating characteristic (ROC) analysis and AUC (area under the curve) results were identified. Results: A total of 126 IE patients were included, 54% with negative blood cultures at admission. Overall, the in-hospital mortality was 28.6%, higher in the blood culture-negative than positive group (17.5% vs. 11.1%, p = 0.207). A significant increase in the Model for End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) score was observed in the blood culture-negative group (p = 0.004), but no baseline characteristics differed between the groups. The best laboratory predictors of in-hospital death in the total study group were the neutrophil count (AUC = 0.824), white blood cell count (AUC = 0.724) and MELD-XI score (AUC = 0.700). Conclusion: Classic laboratory parameters, such as the white blood cell count and neutrophil count, were associated with in-hospital mortality in infective endocarditis. In addition, MELD-XI was a good predictor of in-hospital death.

Highlights

Infective endocarditis (IE) has a relatively low incidence, but mortality remains high (15–30%) and has changed little in recent decades, despite new diagnostic methods and treatment options [1]
This study aimed to describe the epidemiological, clinical and paraclinical parameters in infective endocarditis to establish possible differences between blood culture-negative and blood culture-positive groups, and to explore the laboratory findings that are associated with in-hospital mortality
47.6% of the patients had a history of cardiovascular disease (CVD) predisposing for developing IE, and 17.5% had diabetes mellitus

Summary

Introduction

Infective endocarditis (IE) has a relatively low incidence, but mortality remains high (15–30%) and has changed little in recent decades, despite new diagnostic methods and treatment options [1]. Infective endocarditis has many variable forms of presentation, from the classical association between fever and a new-onset cardiac murmur, to unspecific clinical aspects, such as embolic stroke, heart failure and absence of fever. The diagnosis of IE remains a challenge, and a combination of clinical, microbiological and echocardiographic findings forms the diagnostic criteria, the most frequently used being the modified Duke criteria [1]. These challenges often lead to delayed diagnosis and treatment

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