Abstract
BackgroundDespite medical advances, mortality in infective endocarditis (IE) is still very high. Previous studies on prognosis in IE have observed conflicting results. The aim of this study was to identify predictors of in-hospital mortality in a large multicenter cohort of left-sided IE.MethodsAn observational multicenter study was conducted from January 1984 to December 2006 in seven hospitals in Andalusia, Spain. Seven hundred and five left-side IE patients were included. The main outcome measure was in-hospital mortality. Several prognostic factors were analysed by univariate tests and then by multilogistic regression model.ResultsThe overall mortality was 29.5% (25.5% from 1984 to 1995 and 31.9% from 1996 to 2006; Odds Ratio 1.25; 95% Confidence Interval: 0.97-1.60; p = 0.07). In univariate analysis, age, comorbidity, especially chronic liver disease, prosthetic valve, virulent microorganism such as Staphylococcus aureus, Streptococcus agalactiae and fungi, and complications (septic shock, severe heart failure, renal insufficiency, neurologic manifestations and perivalvular extension) were related with higher mortality. Independent factors for mortality in multivariate analysis were: Charlson comorbidity score (OR: 1.2; 95% CI: 1.1-1.3), prosthetic endocarditis (OR: 1.9; CI: 1.2-3.1), Staphylococcus aureus aetiology (OR: 2.1; CI: 1.3-3.5), severe heart failure (OR: 5.4; CI: 3.3-8.8), neurologic manifestations (OR: 1.9; CI: 1.2-2.9), septic shock (OR: 4.2; CI: 2.3-7.7), perivalvular extension (OR: 2.4; CI: 1.3-4.5) and acute renal failure (OR: 1.69; CI: 1.0-2.6). Conversely, Streptococcus viridans group etiology (OR: 0.4; CI: 0.2-0.7) and surgical treatment (OR: 0.5; CI: 0.3-0.8) were protective factors.ConclusionsSeveral characteristics of left-sided endocarditis enable selection of a patient group at higher risk of mortality. This group may benefit from more specialised attention in referral centers and should help to identify those patients who might benefit from more aggressive diagnostic and/or therapeutic procedures.
Highlights
Despite medical advances, mortality in infective endocarditis (IE) is still very high
During the past few years, several published epidemiological studies have identified a number of prognostic factors related to higher mortality, such as advanced age [6,7], female gender [6], prosthetic valve endocarditis [6,7], Staphylococcus aureus aetiology [6,7,8,9,10], comorbidity [6,9], analytical data, and the development of various complications
More accurate information may be obtained from prospective multicenter studies, in which it is possible to include a large number of cases based on strict diagnostic criteria
Summary
Mortality in infective endocarditis (IE) is still very high. The aim of this study was to identify predictors of in-hospital mortality in a large multicenter cohort of left-sided IE. The diagnostic and therapeutic advances of recent years have only marginally reduced mortality associated with infective endocarditis (IE). Studies investigating prognostic factors for IE frequently have methodological flaws since they are based on short retrospective series, the experience of a single hospital, or use non-uniform diagnostic criteria. Many of these studies are performed in referral centers, where the most complicated cases are usually treated [14]. Our objective was to investigate factors associated with a worse prognosis in a multicenter cohort of left-sided IE patients
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