Left-sided infective endocarditis: analysis of in-hospital and medium-term outcome and predictors of mortality

• Autor(a) principal: Ferreira, J.
• Data de Publicação: 2013
• Outros Autores: Gomes, F., Rodrigues, P., Araújo Abreu, M., Maia, J., Bettencourt, P., Luz, A., Torres, S., Araújo Correia, J.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.16/1602
• topic: Infective; endocarditis; Outcome; Analysis; Mortality

Abstract Introduction: Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a challenging and potentially lethal disease. The prognosis of IE remains poor; in the last 30 years, its incidence and mortality have only been marginally reduced. Early identification of high-risk patients can change the course of the disease and improve outcomes. Objectives and methods: To describe and investigate predictors of mortality during hospital stay and in the six months after discharge in a cohort of left-sided IE patients in two tertiary centers. All patients diagnosed with IE (ICD9 code 133) were registered in a uniform database. Results: One hundred and forty-seven consecutive case patients with left-sided IE were included in this study. Thirty-five patients (23.8%) died during hospital stay. The variables significantly associated with increased mortality in univariate analysis were Charlson index ≥5, use of immunosuppressants, sepsis (severe sepsis and/or septic shock), cardiogenic shock and inappropriate use of antibiotic therapy. Conversely, surgical therapy and hospital length of stay ≥30 days were significantly associated with lower mortality. In multivariate analysis the most important predictors of in-hospital mortality were sepsis (severe and/or shock), use of immunosuppressants and inappropriate use of antibiotic therapy. There was a significant relation between the use of immunosuppressants and the occurrence of sepsis. The presence of significant valve disease after IE significantly increased the risk of heart failure. Conclusions: Our results may help to identify IE patients at increased risk for in-hospital mortality and medium-term disability. These findings can help to identify candidates for earlier and more aggressive management.