Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases.

Maarja Maser,Jeanette Köppe,Helmut Baumgartner,Gerrit Kaleschke,Eva Freisinger,Astrid Lammers,Stefan Orwat,Gerhard-Paul Diller,Leo Bronstein

doi:10.3390/jcm10215071

Abstract

Background: Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The aim of this study was to analyse the frequency and outcome of IE in contemporary CHD patients based on all IE hospital admissions in Germany over a 10-year period. Methods: Based on data of all hospital admissions in Germany from 2009 to 2018, we identified all CHD cases with a diagnosis of IE. The data contained information on patient demographics, diagnoses, surgical procedures, and mortality. The primary endpoint of the study was endocarditis-associated mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis, renal dialysis, resuscitation, or intubation). Results: Overall, 309,245 CHD inpatient cases were included in the analysis (underlying heart defects of simple complexity 55%, moderate complexity 23%, and complex heart defects 22%, respectively). Of those, 2512 (0.8% of all inpatient cases) were treated for IE. The mortality rate of IE inpatient cases was 6% with a major adverse events rate of 46%, and 41.5% of cases required surgical intervention. The overall IE associated mortality was lower in adult CHD cases compared to the 153,242 in adult IE cases without CHD (7.1% vs. 16.1%, p < 0.001). After adjustments using multivariable logistic regression analysis, the presence or complexity of CHD was not associated with the outcomes. Meanwhile, age, male sex, and co-morbidities emerged as significant predictors of adverse outcomes. Conclusions: IE accounts for a minority of CHD related hospitalizations but remains a deadly disease, and major adverse events are common in this setting. Due to different demographic and co-morbidity spectrums, adult CHD patients tend to have better survival prospects when compared to non-CHD IE patients. Acquired co-morbidities emerged as the main predictors of adverse outcomes.

Highlights

Infective endocarditis (IE) remains one of the major complications affecting patients with structural or valvular lesions, as well as those with congenital heart disease (CHD) [1,2,3].With ongoing improvements in the early management of children born with CHD and better survival prospects of newborns with the condition, CHD has been transformed from a purely paediatric condition with a dismal prognosis, to a chronic life-long condition [3,4,5,6].In the modern era, over 90% of children with CHD are expected to survive to adulthood in high resource countries [3]
When assessing risk factors for adverse outcomes in comparison to non-congenital IE cases, we found that a diagnosis of CHD or complexity of CHD were not directly associated with adverse outcomes
We found that acquired co-morbidities such as diabetes, a diagnosis of heart failure, occurrence of renal dysfunction, coronary heart disease, or pulmonary disease were significantly associated with adverse outcomes

Summary

Introduction

Infective endocarditis (IE) remains one of the major complications affecting patients with structural or valvular lesions, as well as those with congenital heart disease (CHD) [1,2,3].With ongoing improvements in the early management of children born with CHD and better survival prospects of newborns with the condition, CHD has been transformed from a purely paediatric condition with a dismal prognosis, to a chronic life-long condition [3,4,5,6].In the modern era, over 90% of children with CHD are expected to survive to adulthood in high resource countries [3]. Infective endocarditis (IE) remains one of the major complications affecting patients with structural or valvular lesions, as well as those with congenital heart disease (CHD) [1,2,3]. Avoidance and treatment of IE remains of major interest in the long-term care of CHD patients It is unclear whether CHD or associated co-morbidities are the major drivers of adverse outcomes in this population. Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The mortality rate of IE inpatient cases was 6% with a major adverse events rate of 46%, and 41.5% of cases required surgical intervention. Conclusions: IE accounts for a minority of CHD related hospitalizations but remains a deadly disease, and major adverse events are common in this setting

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