Outcome of Infective Endocarditis: Improved Results over 18 Years (1990-2007)

Abstract

Background: High morbidity and mortality characterize patients suffering infective endocarditis (IE). The treatment of IE has undergone significant changes within ten years but it is not known whether mortality has decreased and which factors are determinant of the outcome. Objectives: Our aim was to evaluate the prognostic significance of clinical characteristics and outcomes of IE. Methods and Results: 312 definite cases of IE diagnosed using the Duke criteria were evaluated. Overall in-hospital mortality was 28%. Independent predictors of death, determined by a Weibull regression model, in medically-treated patients were (1) treatment era 1990–1995 vs. 2005–2007 (hazard ratio 3.14; 95% CI 1.37−7.21); (2) aging for each year (hazard ratio 1.02; 95% CI 1.004−1.03); (3) cardiac complications (hazard ratio 1.91; 95% CI 1.06−3.43); and (4) heart failure (hazard ratio 2.27; 95% CI 1.34−3.85). Independent predictors of the death in surgically-treated patients were (1) treatment era 2001–2004 vs. 2005–2007 (hazard ratio: 0.31; 95% CI 0.10−0.97), (2) aging for each year (hazard ratio: 0.96; 95% CI 0.94−0.99), and (3) cardiac complications (hazard ratio: 1.91; 95% CI 1.01−3.63). Conclusions: Some of the predictive factors for a poor prognosis were the same as those observed in previous studies. These factors could be used to identify those patients for more aggressive treatment. A new finding was the hazard function for mortality being highest at enrollment and declining rapidly in both medically and surgically treated patients, especially during the first 12 months.