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Rev Port Cardiol. 2013 Oct;32(10):777-84. doi: 10.1016/j.repc.2012.11.015. Epub 2013 Oct 25.

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

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1
Internal Medicine and Cardiology Departments, Centro Hospitalar do Porto, Porto, Portugal; Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal. Electronic address: jp7ferreira@hotmail.com.

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.

KEYWORDS:

Analysis; Análise; Endocardite infecciosa; Infective endocarditis; Mortalidade; Mortality; Outcome; Prognóstico

PMID:
24209740
DOI:
10.1016/j.repc.2012.11.015
[Indexed for MEDLINE]
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