Prognostic predictors in infective endocarditis: a registry of a reference hospital from 2016-2022

Abstract

Abstract Funding Acknowledgements None. Introduction Infective endocarditis (IE) is a cardiovascular pathology with a poor prognosis due to its intra- and extracardiac complications, which sometimes contraindicate surgery and determine its prognosis. OBJECTIVES Our aim was to analyze the prognostic determinants of patients diagnosed with IE. Material and Methods We included patients admitted to a cardiac surgery referral hospital with a diagnosis of IE from 2016-2022. We documented cardiac involvement, extracardiac complications, as well as whether or not cardiac surgery was performed. Their long-term monitoring included checking for major adverse events, such as cardiovascular (CVM) and all-cause mortality (A-CM). The use of Cox regression models resulted in the establishment of prognostic determinants. Results Among 162 patients (males 70.5%; median age 66 years old, P25: 58, P75: 76), the most frequent location of IE was aortic valve (44%), followed by mitral (31.9%), mostly native (50.6%). Fifty percent of the patients were diagnosed with recently developed valve dysfunction. The most frequent local cardiac complications were abscess (21.2%) and chordal/veil rupture (10.2%). The incidence of cerebral embolism was 21.8% and shock was up to 19.9%. In-hospital mortality rate was high (24.7%), with 82.6% not having undergone surgery. At the follow-up (mean 35.7 months), it was noted that there was a rate of 22.9% CV mortality and 35.7% overall mortality; of these patients, the majority had no prior surgical intervention (69.9%). Predictors of all-cause and CV mortality at follow-up were shock (HR 4.12 CI95% 1.7-10 in CVM, p=0.02 and HR 3.8 CI95% 1.9-7.4 in A-CM, p<0.01), diabetes mellitus (CVM HR 7.82 CI95% 3.15-19.4 p<0.01; A-CM HR 2.6 CI95% 1.4-5 p<0.01), history of oncological disease (CVM HR 3.21 CI95% 1-10.3 p=0.05; A-CM HR 3.4 CI95% 1.4-7.9 p<0.01), complete atrioventricular block (CVM HR 3.03 95% 1.1-8.5 p=0.04; A-CM HR 3 CI95% 1.4-6.8 p<0.01) and valvular dysfunction (CVM HR 7.82 CI95% 3.15-19.4 p<0.01; A-CM HR 1.59 CI95% 1.1-2.4 p=0.03). Low rates of EI recurrence (6.6%) and readmission (14.6%) were detected, with no statistically significant relationship with surgery. Adjusted for valve type (aortic or mitral), operated patients had a better prognosis (HR 0.24, 95%CI 0.08-0.72, p=0.02) with a longer median survival (64.5 vs 51.1 months, p=0.05). Conclusion Infective endocarditis has a mortality rate of up to 25% in our series, mostly in-hospital, which is associated with shock, AVB, valvular dysfunction and a history of diabetes mellitus and oncological disease. Surgery seems to provide benefits regardless of the type of valve involved.