Prognosis Of Infective Endocarditis Research Articles

Infective endocarditis caused by Gemella – a retrospective registry-based study

Purpose Infective endocarditis (IE) is diagnosed using the Duke criteria, which were updated in 2023. In the Duke-ISCVID 2023 criteria, Gemella was recognised as a typical IE pathogen. This study investigates the impact of this change and compares the clinical characteristics of Gemella IE to IE caused by other pathogens. Methods Data on IE caused by Gemella species and other pathogens was retrieved from the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of Gemella IE were compared to episodes of IE caused by non-beta haemolytic streptococci, by Staphylococcus aureus and by enterococci. Results In the SRIE, 29 episodes of Gemella IE were identified among a total of 7677 registered episodes, corresponding to 0.4% of all cases. The most common species were Gemella morbillorum (47%) and Gemella bergerii (27%). The proportion of episodes meeting the criteria for definite IE increased from 13 (45%) with the modified Duke criteria to 21 (72%) with the Duke-ISCVID criteria. Median age of patients with Gemella IE was 70 years, 40% were females and 90% hade native valve IE. One third of the patients underwent heart valve surgery and only one patient (3%) died. Many clinical aspects of IE caused by Gemella resembled those of IE caused by non-beta haemolytic streptococci. Conclusions Gemella IE is a rare condition and shares several characteristics with IE caused by non-beta haemolytic streptococci. The prognosis of IE caused by Gemella appears to be relatively favourable.

Outcomes of infective endocarditis in patients with end-stage renal disease and dialysis in Spain: a population-based study

Abstract Background Patients with end-stage renal disease (ESRD), particularly those undergoing dialysis, have a significantly higher risk of developing infective endocarditis (IE) compared to the general population. ESRD is not only related to a higher risk of infection, but also to a worse prognosis in IE. However, most data regarding the epidemiology and outcomes of patients with ESRD and IE is derived from noncontemporary population-based studies with limited clinical variables and lack of complete microbiological information, or from retrospective single-center cohorts. Purpose The aim is to describe the clinical characteristics and outcome of patients with IE and ESRD in Spain, compared to patients without ESRD, and to investigate potential differences between patients undergoing dialysis and the rest of patients with ESRD. Methods Retrospective observational population-based study. A total of 9,008 episodes of IE between 2016 and 2019 were analysed using information from the Spanish Minimum Basic DataSet. 428 patients had ESRD, of whom 332 were undergoing dialysis. A multivariable and multilevel logistic model was developed to evaluate the association of different variables with in-hospital mortality in ESRD patients. Results Compared to patients without ESRD, those with ESRD were younger, had more comorbidities, and had a higher incidence of Staphylococcus aureus (31.8% vs. 18.4%; p <0.001) and coagulase-negative staphylococci infections (19.2% vs. 14%; p =0.006). In terms of in-hospital complications, septic shock was more frequent in patients with ESRD (12.1% vs. 8.9%; p=0.007). Furthermore, ESRD patients underwent cardiac surgery less frequently than patients without ESRD (12.6% vs. 19.6%; p <0.001) and had significantly higher in-hospital mortality (33.4% vs. 26.9%; p =0.003). When comparing patients undergoing dialysis with the rest of ESRD patients, it was observed that those on dialysis had more comorbidities and a higher proportion of Staphylococcus aureus infections (36.1% vs. 16.7%; p <0.001). No differences were found in observed in-hospital mortality between patients on dialysis and the rest of ESRD patients. The multilevel analysis revealed that dialysis was not an independent risk factor for in-hospital mortality in patients with ESRD. Cardiac surgery was also not independently associated with higher in-mortality in ESRD patients. Conclusions Patients with ESRD and IE have a different clinical and microbiological profile than other patients with IE. Moreover, they undergo cardiac surgery less frequently and have significantly higher in-hospital mortality. Dialysis treatment and cardiac surgery were not independent risk factors for mortality in ESRD patients with IE.

Infective endocarditis in HIV-infected patients. Analysis of a national cohort

Background There is limited recent evidence about infective endocarditis (IE) in HIV-infected patients. Our aim was to compare IE according to HIV infection presence. Methods Consecutive inclusion of IE patients at 46 Spanish hospitals between 2008 and 2021. Results From 5667 patients, 99 were HIV-infected (1·7%; 50 intravenous drugs users). Compared to patients without HIV, HIV-infected patients were more frequently male (84% vs. 67%), had younger median age (46 vs. 69 years), and less comorbidities, except liver disease (52% vs. 9%) and intravenous drug use (51% vs. 1%). They had more common tricuspid location (36% vs. 5%) and community-acquired IE (82% vs. 63%), vascular (29% vs. 17%) and cutaneous (22% vs. 7%) foci of infection, and Staphylococcus aureus aetiology (46% vs. 22%). Vegetations (84% vs. 72%), vascular phenomena (17% vs. 9%), splenomegaly (30% vs. 11%), and embolisation (41% vs 21%) were also more common. Surgical indication and surgery were less frequent in HIV-infected patients (54% vs 67%, 28% vs 47%, respectively). Median CD4 count in HIV-infected patients was 318 cells/mm3. In-hospital mortality (23% vs. 26%) and one-year mortality (25% vs. 32%) were similar in both groups. HIV infection was not independently associated with in-hospital (odds ratio 1·1, 95% CI 0·6–1·9) nor one-year mortality (hazard ratio 0·8, 95% CI 0·4–1·3). Conclusions In the combined antiretroviral therapy era, less than 2% of IE patients have HIV infection. HIV-infected patients have a different clinical profile than those without HIV, but the presence of HIV does not seem to impact on IE prognosis.

Epidemiology, outcomes and prognosis of infective endocarditis in Northern Morocco

IntroductionInfective endocarditis is a rare but potentially severe disease, associated with significant morbidity and mortality. Our study aims to describe the epidemiology and management aspects of endocarditis in northern Morocco and compare it with international management guidelines.Materials and MethodsThis is a retrospective study involving all patients hospitalized in the cardiology department of the University Hospital of Tangier for infective endocarditis over a period of 4 years and 7 months, from May 2019 to February 2024.ResultsEighty patients were hospitalized for IE during the study period. The average age of the patients was 46 years, with an even sex ratio. IE concerned native valves in 77% of cases, mechanical prostheses in 19% of cases, and on bio prostheses in 4%. The average diagnostic delay was 25 days. Blood cultures were negative in 59% of cases. The predominant infective microorganism was the bacteria Staphylococcus (65.6%).Imaging results showed vegetations in 76.3% of cases, predominantly on the mitral valve (39.3%), followed by the aortic valve (21.3%). The main complications included heart failure (51.2%), peripheral arterial embolisms (22.5%) and splenic infarction (17.5%).Management wise, the most commonly used antibiotic therapy was a combination of ceftriaxone and gentamicin. Clinical and biological improvement was observed in 70% of cases, with a mortality rate of 12.5%. Twelve patients underwent surgery (15%). Urgent surgery was indicated in 66,7% of the operated patients.ConclusionOur study highlights the challenges in managing infective endocarditis in northern Morocco. The prognosis of infective endocarditis can be improved through multidisciplinary management within the implementation of an Endocarditis Team.

The Role of Echocardiography in the Diagnosis of Infective Endocarditis and its Complications

Infective endocarditis (IE) remains associated with high morbidity and mortality rates despite advances in medical technology, diagnostics, and treatment. Hospital mortality for IE reaches up to 22%, with a five-year mortality rate of 40%. Globally, the incidence of IE has increased, with recent figures indicating 13.8 cases per 100,000 annually, up from 1.5–11.6 per 100,000 reported between 1990 and 2010. A retrospective cohort study in a tertiary care center in Korea demonstrated a significant rise in the monthly incidence of IE from 2.0 in 2005 to 3.8 in 2017. This increase is attributed to the enhanced utilization of diagnostic tools such as echocardiography, computed tomography (CT), and positron emission tomography (PET). The 2015 European Society of Cardiology (ESC) guidelines incorporated complementary imaging modalities like Single Photon Emission Computed Tomography-CT (SPECT/CT), 18F-FDG PET/CT, and Cardiac CT, alongside traditional transthoracic and transesophageal echocardiography. The 2023 ESC guidelines further expanded these algorithms to include Cardiac CTA, MRI, PET/CT, and WBC SPECT. However, transthoracic, and transesophageal echocardiography remain the primary and essential diagnostic tools for suspected IE. This review examines the role of echocardiography in diagnosing IE, highlighting typical ultrasound findings, valve damage, and associated complications. Ultrasound is pivotal for early detection and prognosis of IE, identifying vegetations, abscesses, pseudoaneurysms, and fistulas. New vegetations typically appear irregular and oscillate, with transthoracic echocardiography detecting vegetations larger than 5mm with 90% sensitivity. Detailed echocardiographic assessment provides critical insights for the surgical management of IE and enhances the understanding of IE’s complex pathology.

Infective Endocarditis-Characteristics and Prognosis According to the Affected Valves.

Infective endocarditis (IE) continues to be a disease with high mortality despite medical advances. The objective of this study was to investigate the characteristics and prognosis of IE according to the affected valves. This study was retrospective and single-centered, and it included 270 patients with a diagnosis of IE, for the period 2005-2021, who received treatment at the University Hospital "St. Georgi" in Plovdiv, Bulgaria. Single-valve IE (SIE) was found in 82.6% (n-223), multivalvular IE (MIE) in 16.66% (n = 45) and device IE (CDRIE) in 0.74% (n = 2) of patients. The most commonly affected valve was the aortic valve, in 44.8% (n = 121). The predominant multivalvular involvement was aortic-mitral valves (AV-MV) (13.7%, n = 37). The patients with tricuspid valve (TV) IE were significantly younger, at 39 (30) years, and were more frequently male (80.8%). Mortality was higher in MIE than in SIE (31.1% vs. 23.8%) and was the highest in multivalve aortic-tricuspid (AV-TV) IE (75%). Early surgery was performed most in AV-MV IE, in 29.7% (n = 11). The Charlson comorbidity index (CCI) was significantly higher in MV 4 (4) and AV 3 (3) vs. TV IE 1 (5) (p = 0.048 and p = 0.011, respectively). Septic shock occurred most frequently in AV-TV involvement (75%; p = 0.0001). The most common causative agents were of the Staphylococcus group. Staphylococcus aureus more often affected TV alone (46.2%, n = 124) vs. AV (9.9%, n = 14; p = 0.0001) and vs. MV (22.6%, n = 17; p = 0.022); Staphylococcus coagulase-negative (CNG) was the prevalent cause of MV IE (22.7%, n = 17) vs. AV-MV (2.7%, n = 1; p = 0.007). Streptococci were represented in a low percentage and only in left-sided IE, more frequently in AV-MV (18.9%, n = 7) vs. AV (6.6%, n = 8; p = 0.025). The aortic valve is the most frequently affected valve, as single-valve IE or as multivalve AV-MV, with the predominant causative agents being of the Staphylococcus group. AV-TV IE has the worst prognosis, with the most common complication of septic shock and the highest in-hospital mortality.

Impact of the SARS-CoV-2 Pandemic on the Management and Prognosis of Infective Endocarditis.

Infective endocarditis (IE) is a serious condition which is difficult to diagnose and to treat, both medically and surgically. The objective of this study was to evaluate the impact of the SARS-CoV-2 pandemic on the management of patients with IE. We conducted a single-centre retrospective study including patients hospitalized for IE during the pandemic (Group 2) compared with the same period the year before (Group 1). We compared clinical, laboratory, imagery, therapeutic, and patient outcomes between the two groups. A total of 283 patients were managed for possible or definite IE (164 in Group 1 and 119 in Group 2). There were more intravenous drug-related IE patients in Group 2 (p = 0.009). There was no significant difference in surgery including intra-cardiac device extraction (p = 0.412) or time to surgery (p = 0.894). The one-year mortality was similar in both groups (16% versus 17.7%, p = 0.704). The recurrence rate was not significantly different between the two groups (5.9% in Group 2 versus 9.1% in Group 1, p = 0.311). The SARS-CoV-2 pandemic did not appear to have had a negative impact on the management of patients with IE. Maintenance of the activities of the endocarditis team within the referral centre probably contributed to this result. Nevertheless, the high proportion of intravenous drug-addicted patients in the pandemic cohort suggests that the SARS-CoV-2 pandemic had a major psychosocial impact.

Trends in epidemiology, surgical management, and prognosis of infective endocarditis during the XXI century in Spain: A population-based nationwide study

BackgroundFew population-based studies have evaluated the epidemiology of infective endocarditis (IE). Changes in population demographics and guidelines on IE may have affected both the incidence and outcomes of IE. Therefore, the aim of our study is to provide contemporary population-based epidemiological data of IE in Spain. MethodsRetrospective nationwide observational study using data from the Spanish National Health System Discharge Database. We included all patients hospitalized with IE from January 2000 to December 2019. ResultsA total of 64,550 IE episodes were included. The incidence of IE rose from 5.25 cases/100,000 person-year in 2000 to 7.21 in 2019, with a 2% annual percentage change (95% CI 1.3–2.6). IE incidence was higher among those aged 85 or older (43.5 cases/100.000 person-years). Trends across the study period varied with sex and age.Patients with IE were progressively older (63.9 years in 2000–2004 to 70.0 in 2015–2019, p < 0.001) and had more frequent comorbidities and predispositions, including, previous valvular prosthesis (12.1% vs 20.9%, p < 0.001). After adjustment, a progressive reduction in mortality was noted including in 2015–2019 compared to 2010–2014 (adjusted odds ratio 0.93, 95% confident interval 0.88–0.99, p = 0.023)., which was associated with more frequent cardiac surgery in recent years (15.1% in 2010–2014 vs 19.9% in 2015–2019). ConclusionsIn Spain, the incidence of IE has increased during the XXI century, with a more pronounced increase in elderly individuals. Adjusted-mortality decreased over the years, which could be related to a higher percentage of surgery. Our results highlight the changing epidemiology of IE.

Epidemiological, Bacteriological, and Evolutive Features of Children Hospitalized for Infective Endocarditis in a Tertiary Tunisian Pediatric Department.

Infective endocarditis is a rare condition in childhood, and there is limited data on this disease in Tunisia. This study aims to analyze the epidemiological profile, bacteriological data, and prognosis of infective endocarditis in children admitted to the pediatric department of a University Hospital in Tunisia. We conducted a comparative cross-sectional study in the pediatric department of Sahloul Teaching Hospital in Sousse, a tertiary referral hospital in Tunisia. The study included all children aged ≤ 18 years with infective endocarditis admitted to the tertiary referral center for pediatrics in Sahloul University Hospital from January 1994 to December 2022. The diagnosis of infective endocarditis was based on modified Duke's criteria. Thirty-six patients met the diagnostic criteria for infective endocarditis, resulting in a proportion of 07 cases per 1000 hospital admissions. The mean age was 6 years (range: 40 days to 16 years). Congenital heart disease was identified as the underlying lesion in 23 cases (63.9 %). Blood cultures were positive in 20 patients (55.6 %), predominantly with Staphylococcus species (55 %). The most frequent complications involved the central nervous system (8 cases; 22.2 %). The mortality rate was 25 %, and factors predicting mortality included heart failure on admission or during the hospital stay, increased leukocyte count, and decreased prothrombin time. Our study reveals a shift in the prevalent underlying lesions, with rheumatic heart diseases no longer being the most common. Staphylococcus spp. emerged as the predominant organism in blood cultures. Notably, mortality predictors included heart failure, an elevated leukocyte count, and a decreased prothrombin time rate.

Is Infectious Endocarditis Evolving into a Time-Dependent Diagnosis in the Contemporary Epidemiological Era? Emphasis on the Role of Echocardiography as a First-Line Diagnostic Approach.

Despite significant advances in understanding and outcomes in various domains of cardiology, the prognosis of infective endocarditis (IE) remains dismal. One of the main reasons may rely on an even more intricate diagnosis since epidemiology has shifted towards an aggressive infection, typically in older patients with the involvement of prosthetic valves and cardiovascular implantable electronic devices with earlier clinical presentation. In this novel setting, it is critical to avoid a delay in diagnosis that may delay subsequent adequate treatment, further complications, and ultimately poor clinical outcomes. Accordingly, based on the available data, we will examine the proper use of first-line echocardiography representing the first-line imaging method in patients with clinical suspicion of IE. We will focus on the following three crucial questions: (1) What is the threshold to start the echocardiographic diagnostic workup in stable patients? (2) Has infective endocarditis become a time-dependent diagnosis, even in stable patients? (3) What is the appropriate use of echocardiography in unstable patients? Finally, we propose a new mindset to improve the echocardiographic diagnostic workflow.

Clinical Profile and Predictors of Poor Prognosis in Infective Endocarditis

ABSTRACT Context: Infective endocarditis (IE) is associated with high morbidity and mortality despite advances in diagnosis and treatment. A recent knowledge of the epidemiology and clinical spectrum of IE is essential for prompt recognition and effective therapy. Aims: This study aims to determine the clinical profile, and outcome of patients with IE and to identify the clinical and laboratory predictors of poor prognosis in patients with IE. Settings and Design: This is a prospective observational study among patients diagnosed with IE in a tertiary care center over a period of 12 months. Subjects and Methods: We collected the demographic, clinical, and laboratory evaluation details of consecutive patients admitted with IE. All the patients were followed during hospitalization for mortality, complications, and need for surgery. Statistical Analysis Used: The comparison of mean values across the different outcome groups was done using one-way analysis of variance test. The association between the categorical independent variables with the outcome was evaluated using the Pearson Chi-square test. Results: Among 75 patients admitted with IE rheumatic heart disease was the most common predisposing condition. Blood culture was positive in 80%. Staphylococcus aureus was the most common organism. Total in-hospital mortality was 32%. Staphylococcal IE had 43% mortality and fungal IE had 57% mortality. Prosthetic valve endocarditis also had 57% mortality. Surgery was undertaken in 28% of patients and surgical mortality was 19%. Presence of heart failure, thrombocytopenia, leukocytosis, elevated neutrophil-to-lymphocyte ratio, elevated platelet-to-lymphocyte ratio, high serum creatinine, and C-reactive protein were associated with high mortality. Conclusions: The mortality associated with IE remains high. Clinical and laboratory parameters can reliably predict poor prognosis in IE.

Mitro-aortic infective endocarditis on bicuspid aortic valve multicomplicated: a case report.

Infective endocarditis (IE) is a rare but serious disease, and despite improvements in diagnostic and therapeutic tools, it remains associated with high mortality. It can develop in a healthy heart, but most commonly in underlying heart disease. The authors discuss a 34-year-old patient, who has presented for 4 months with generalized asthenia, fever, and chills, without any notion of chest pain, arthralgias. On admission, the patient was conscious, hemodynamically, and respiratory stable, the temperature was 38.5°C. The cardiac exam heart revealed a systolic murmur rated 4/6th at the mitral focus. Transthoracic echocardiography showing vegetation on the mitral and aortic valve. Three blood cultures were taken at 1h intervals, all positive for enterococci, thoracoabdominal and brain computed tomography scan with contrast injection was performed showing, ischemic stroke, aortic coarctation, splenic and renal infarction, mycotic aneurysms in the descending aort. IE can be the cause of several extracardiac manifestations, through vascular and/or immunological phenomena. Embolic complications are the most frequent extracardiac complications and are secondary to septic emboli from the vegetations. The prognosis of IE is worsened by the addition of cardiac and extracardiac complications such as mycotic aneurysms and septic embolic events.

Case Study: Abnormal Presentation of Infective Endocarditis With Streptococcus Canis and Chiari Network

Here we present a rare case of infective endocarditis (IE) with Streptococcus canis and Chiari network in an 85 year old female living with multiple dogs and open skin of lower extremity predisposing her to bacteremia. Underlying abnormalities of the cardiac chambers such as Chiari network predisposes to a higher incidence of bacterial seeding and causing IE. A Chiari network is usually asymptomatic and of no clinical significance but can worsen prognosis in IE. IE carries a significant morbidity and mortality burden and when diagnosed early can be a lifesaving diagnosis. Due to the wide range of complications, early diagnosis and treatment with targeted antimicrobial therapy and consideration of early surgical intervention are vital to the evaluation and treatment of IE. Though Staphylococci, Streptococci, Enterococci, HACEK organisms amount for the majority of IE, some atypical organisms including group G Streptococci such as S. canis have been reported to carry high mortality and hospitalization risk in patients with bacteremia. S. canis is a group G beta-hemolytic Streptococci which normally resides on the skin and mucosal surfaces of dogs. This Case Report shines light on the versatility of microorganisms that can cause IE in a patient with underling Chiari network, and the risk of morbidity and mortality with such species highlighting the importance of early diagnosis and treatment.

Infective endocarditis in adult patients with congenital heart disease

BackgroundCongenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. MethodsThe ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. ResultsCHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50–0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36–14.47]), cerebral embolus (HR 4.64 [2.08–10.35]), renal insufficiency (HR 3.44 [1.48–8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11–3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15–11.18]). ConclusionsCHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

Antibacterial and Antifungal Management in Relation to the Clinical Characteristics of Elderly Patients with Infective Endocarditis: A Retrospective Analysis.

Infective endocarditis (IE) is increasingly prevalent in the elderly, particularly due to the rising frequency of invasive procedures and intracardiac devices placed on these individuals. Several investigations have highlighted the unique clinical and echocardiographic characteristics, the microorganisms implicated, and the prognosis of IE in the elderly. In addition, the old population seems to be fairly diverse, ranging from healthy individuals with no medical history to patients with many ailments and those who are immobile. Furthermore, the therapy of IE in this group has not been well investigated, and worldwide recommendations do not propose tailoring the treatment approach to the patient’s functional state and comorbid conditions. A multicenter research study was designed as a retrospective study of hospitalized patients with infective endocarditis, aiming to examine the characteristics of elderly patients over 65 years old with infective endocarditis in relation to the antibiotic and antifungal treatments administered, as well as to quantify the incidence of treatment resistance, adverse effects, and mortality in comparison to patients younger than 65. Based on a convenience sampling method, we included in the analysis a total of 78 patients younger than 65 and 131 patients older than 65 years. A total of 140 patients had endocarditis on native valves and 69 patients had endocarditis on prosthetic valves. A significantly higher proportion of elderly patients had signs of heart failure on admission, and the mortality rate was significantly higher in the elderly population. A majority of infections had a vascular cause, followed by dental, maxillo-facial, and ENT interventions. The most common complications of IE were systemic sepsis (48.1% of patients older than 65 years vs. 30.8% in the younger group). The most frequent bacterium involved was Staphylococcus aureus, followed by Streptococcus spp. in a total of more than 50% of all patients. The most commonly used antibiotics were cephalosporins in 33.5% of cases, followed by penicillin in 31.2% and glycopeptides in 28.7%, while Fluconazole was the initial option of treatment for fungal endocarditis in 24.9% of cases. Heart failure at admission (OR = 4.07), the development of septic shock (OR = 6.19), treatment nephrotoxicity (OR = 3.14), severe treatment complications (OR = 4.65), and antibiotic resistance (OR = 3.24) were significant independent risk factors for mortality in the elderly patients. Even though therapeutic management was initiated sooner in the older patients, the associated complications and mortality rate remained significantly greater than those in the patients under 65 years old.

Infective Endocarditis in Diabetic Patients: A Different Profile with Prognostic Consequences.

Background. Infective Endocarditis (IE) is a severe condition. Diabetes mellitus (DM) has been associated with a poor prognosis in other settings. Our aim was to describe the profile and prognosis of IE with and without DM and to analyze the prognostic relevance of DM-related organ damage. Methods. Retrospective analysis of the Spanish IE Registry (2008–2020). Results. The cohort comprises 5590 IE patients with a mean age of 65.0 ± 15.5 years; 3764 (67.3%) were male. DM was found in 1625 patients (29.1%) and 515 presented DM-related organ damage. DM prevalence during the first half of the study period was 27.6% vs. 30.6% in the last half, p = 0.015. Patients with DM presented higher in-hospital mortality than those without DM (521 [32.1%] vs. 924 [23.3%], p < 0.001) and higher one-year mortality (640 [39.4%] vs. 1131 [28.5%], p < 0.001). Among DM patients, organ damage was associated with higher in-hospital (200 [38.8%] vs. 321 [28.9%], p < 0.001) and one-year mortality (247 [48.0%] vs. 393 [35.4%], p < 0.001). Multivariate analyses showed an independent association of DM with in-hospital (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.16–1.55, p < 0.001) and one-year mortality (OR = 1.38, 95% CI: 1.21–1.59, p < 0.001). Among DM patients, organ damage was independently associated with higher in-hospital (OR = 1.37, 95% CI: 1.06–1.76, p = 0.015) and one-year mortality (OR = 1.59, 95% CI = 1.26–2.01, p < 0.001) Conclusions. The prevalence of DM among patients with IE is increasing and is already above 30%. DM is independently associated with a poor prognosis, particularly in the case of DM with organ damage.

Characterization and outcome analysis of cardiac valve surgery for infective endocarditis

Introduction and objectivesEvaluating the effect of cardiac valve surgery in the context of infective endocarditis (IE), an uncommon and still deadly disease, can be particularly advantageous in whole-nation population-based studies. It allows a high-volume database analysis with a reduction in the impact of selection bias inherent to single center-based observational studies. The objective was to characterize the profile of patients hospitalized with IE and submitted to cardiac valve surgery, and identify factors associated with in-hospital mortality using a populational-based database. MethodsA retrospective nationwide observational study of patients hospitalized with IE based on hospital admissions data between 2010 and 2018 in Portugal. ResultsA total of 7574 patients were analyzed (56.9% male; 68.3±17.3 years old). Of these, 937 patients underwent cardiac valve surgery (75.2% men; mean age 61.1±14.7 years old). Single valve intervention was predominant in nearly three quarters of cases. Surgery on the aortic valve was more frequent. Mitral valve repair occurred in 30% of cases. The in-hospital all-cause postoperative mortality rate was 15.6%. Factors associated with in-hospital mortality were female sex, liver, kidney and coronary disease, valve prosthesis, Staphylococcus spp, acute renal failure and sepsis. ConclusionsThis analysis identified factors associated with worse outcome in surgically managed patients with IE in Portugal. Appropriate early identification of surgical stratification markers that may influence the overall prognosis in IE is crucial in the real world clinical setting.

Prognostic Value of a Novel Parameter in Patients with Infective Endocarditis.

Background Infective endocarditis (IE) has a high rate of mortality and the prognosis of IE was poor. The purpose of this investigation was to explore the value of lactate dehydrogenase (LDH)/lymphocyte and compare it with LDH/lymphocyte percentage (L-LWR) in predicting the in-hospital mortality in IE patients. Methods The investigation cohort contained 147 IE patients between January 2017 and December 2019. We retrospectively went over the medical records and selected admission indexes. Results Compared with IE patients with adverse events, significantly higher levels of LDH/lymphocyte and significantly lower levels of L-LWR were discovered in IE patients without adverse events. After adjustments, L-LWR (odds ratio (OR): 4.558, 95% confidence interval (CI) 1.362-15.256, P = 0.014) still maintained its significant independence. In addition, L-LWR had the highest area under curve (AUC) (0.780, 0.704-0.844, P < 0.001) with good sensitivity (81.89%) and specificity (65.00%) when 34 was selected as the best cutoff value. Conclusions L-LWR is a reliable, low-priced, easily applicable, and independent prognostic parameter for in-hospital death with good performance in patients with IE.

The association between systemic inflammatory response index and in‐hospital mortality in patients with infective endocarditis

BackgroundInfective endocarditis (IE) has a significant mortality, and early identification of high‐risk patients and prediction of poor outcomes is of great significance. In recent years, increasing research has revealed the predictors associated with infective endocarditis prognosis. Systemic inflammatory response index (SIRI) is an important new indicator of inflammation. So far, there have been no reports on the relationship between SIRI and the prognosis of IE patients.HypothesisThe purpose of this study was to explore the value of SIRI in predicting in‐hospital death for patients with infective endocarditis (IE), so as to provide reference for improving the prognosis of patients with IE.MethodA retrospective analysis was performed on the clinical data of patients with IE admitted to the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2019. SIRI was calculated according to the blood routine results of patients at admission; receiver operating characteristic curve was employed to determined the optimal cutoff value of SIRI. Patients were divided into groups (low SIRI group and high SIRI group; nonsurvivor group and survivor group) according to the levels of SIRI or their prognosis, and the general clinical features of the two groups were compared. Univariate and multivariate logistic regression analysis were performed to analyze the independent prognostic factors of in‐hospital death in IE patients.ResultsA total of 147 IE patients meeting the diagnostic criteria were included, including 102 males (69.4%) and 45 females (30.6%). There was statistically significant difference in SIRI level between nonsurvivor group and survivor group (p < .05). After adjusting for the related factors, the risk of in‐hospital death in the high SIRI was still a risk of in‐hospital death with statistical significance (hazard ratio = 5.053, 95% confidence interval: 1.426‒17.905, p = .012).ConclusionsHigher SIRI level is independently associated with the risk of in‐hospital death in IE patients, and can be an independent predictor of poor outcome in IE patients.

Changing profile of infective endocarditis during 31-year time course in a tertiary care hospital

Aim: Infective endocarditis (IE), infection of the endocardial surface of heart, may cause mortality up to 30% despite advancements in medical care. Epidemiology of IE and profile of causative organism has changed in the last years. We aimed to investigate the changing profile of IE over a 31-year period in a tertiary care hospital &#x0D; Material and Method: Medical records of 290 patients treated with the diagnosis of IE between 1974 and 2005 were re-evaluated according to Modified Duke criteria. Forty seven cases were classified as rejected cases. &#x0D; Results: Of the 243 patients 109 was female (44.8%) and 134 male (55.2%). The mean age of the patients was 38±16.4 years (Table). The mean age of the patients showed an increasing trend throughout the time (p&lt; 0.001) ; it was 29 years between 1974- 1980 but increased to 54 years in 2001-2005 period. Rheumatic valvular disease (RVD) was the most frequent underlying heart disease (60%) but showed a declining trend especially in the last years. S. aureus was the most common pathogen in all the time periods (15.2%). Blood cultures were negative in 90 (43%) patients. But the percentage of blood culture negativitiy decreased significantly from 63% in 1981-1985 periods to 28% in 2001-2005 period. (p: 002). Mitral valve was the most common affected valve (52, 44%). Surgery was performed in 74 of the 243 cases (30.5%). In-hospital mortality rate was 30.6. Mortality rate was significantly lower in patients who underwent surgery compared to ones who did not (19.2% vs. 35.8%, p&lt; 0.005). Mortality rate was also lower in patients with community acquired infection compared to ones with nosocomial infection (27% vs 45%). Embolic events, nosocomial infections and surgery were independent risk factors for mortality. &#x0D; Conclusion: The mean age of IE population is increasing, RVD disesase is less commonly seen as an underlying heart and S. aureus is the most common pathogen. These findings are compatible with the reports from developed countries. Surgery displays a protective effect on the prognosis of IE