Outcomes of infective endocarditis in the current era: Early predictors of a poor prognosis

Abstract

BackgroundThe early identification of patients at risk of complications of infective endocarditis (IE) using parameters obtained as part of routine practice is essential for guiding clinical decision-making. This study aimed to identify a parameter at hospital admission that predicts the outcome, adding value to other well-known factors of a poor prognosis in IE. MethodsTwo hundred and three patients with IE were included in this study. Clinical evaluation, echocardiography, blood cultures, and routine laboratory tests were performed at hospital admission. The endpoint was in-hospital mortality. ResultsThe mean age of the patients was 48.2±16.6 years; 62% were male and 38% had rheumatic heart disease. During treatment, cardiac surgery was performed in 111 patients (55%), and the overall in-hospital mortality rate was 32%. In the multivariable analysis, the independent predictors of death were age (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02–1.13), C-reactive protein (CRP) at hospital admission (OR 1.12, 95% CI 1.04–1.21), length of the vegetation at diagnosis (OR 1.15, 95% CI 1.03–1.28), development of heart failure (OR 6.43, 95% CI 2.14–19.33), and embolic events during antimicrobial therapy (OR 12.14, 95% CI 2.11–71.89). ConclusionsAn elevated CRP level at hospital admission and vegetation length at diagnosis were strong predictors of in-hospital mortality in IE, independent of other prognostic parameters, specifically taking into account patient characteristics and complications during therapy.