Abstract
BackgroundDespite advances in medical knowledge, technology and antimicrobial therapy, infective endocarditis (IE) is still associated with devastating outcomes. No reviews have yet assessed the outcomes of IE patients undergoing short- and long-term outcome evaluation, such as all-cause mortality and IE-related complications. We conducted a systematic review and meta-analysis to examine the short- and long-term mortality, as well as IE-related complications in patients with definite IE.MethodsA computerized systematic literature search was carried out in PubMed, Scopus and Google Scholar from 2000 to August, 2016. Included studies were published studies in English that assessed short-and long-term mortality for adult IE patients. Pooled estimations with 95% confidence interval (CI) were calculated with DerSimonian-Laird (DL) random-effects model. Sensitivity and subgroup analyses were also performed. Publication bias was evaluated using inspection of funnel plots and statistical tests.ResultsTwenty five observational studies (retrospective, 14; prospective, 11) including 22,382 patients were identified. The overall pooled mortality estimates for IE patients who underwent short- and long-term follow-up were 20% (95% CI: 18.0–23.0, P < 0.01) and 37% (95% CI: 27.0–48.0, P < 0.01), respectively. The pooled prevalence of cardiac complications in patients with IE was found to be 39% (95%CI: 32.0–46.0) while septic embolism and renal complications accounted for 25% (95% CI: 20.0–31) and 19% (95% CI: 14.0–25.0) (all P < 0.01), respectively.ConclusionIrrespective of the follow-up period, a significantly higher mortality rate was reported in IE patients, and the burden of IE-related complications were immense. Further research is needed to assess the determinants of overall mortality in IE patients, as well as well-designed observational studies to conform our results.
Highlights
Despite advances in medical knowledge, technology and antimicrobial therapy, infective endocarditis (IE) is still associated with devastating outcomes
A total of 4466 unique articles were identified from three databases: PubMed (3334), Scopus (378) and Google Scholar (754), of which fifty-one deemed eligible for the full-text review and twenty-five articles were included in the systematic review and meta-analysis (Fig. 1)
Subgroup analysis showed that a significantly higher IE rate was reported in males than in females (OR: 4.1; 95% confidence interval (CI): 3.38–4.97) (Appendix 1)
Summary
Despite advances in medical knowledge, technology and antimicrobial therapy, infective endocarditis (IE) is still associated with devastating outcomes. No reviews have yet assessed the outcomes of IE patients undergoing short- and long-term outcome evaluation, such as all-cause mortality and IE-related complications. We conducted a systematic review and meta-analysis to examine the short- and long-term mortality, as well as IE-related complications in patients with definite IE. Infective endocarditis (IE) is an infection of the endocardial lining of the heart with pre-existing lesions or on intra-cardiac foreign materials [1]. Bacterial species such as staphylococcus and streptococcus accounts for 80% of cases; it may occasionally be due to fungal pathogens as well [1, 2]. Successful microbial eradication by antimicrobial drugs or by surgical removal of infected materials and draining abscesses are essential for positive outcomes
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