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Long-term prognosis of patients with infectious endocarditis: a 14-year longitudinal study
Authors : I Aguiar Ricardo (Lisbon,PT), P Carrilho-Ferreira (Lisbon,PT), J Rigueira (Lisbon,PT), J Agostinho (Lisbon,PT), I Santos Goncalves (Lisbon,PT), N Andre (Lisbon,PT), T Guimaraes (Lisbon,PT), G Lima Da Silva (Lisbon,PT), R Francisco (Lisbon,PT), M Nobre Menezes (Lisbon,PT), J Fausto Pinto (Lisbon,PT)
I Aguiar Ricardo1
I Santos Goncalves1
G Lima Da Silva1
M Nobre Menezes1
J Fausto Pinto1
1Hospital Universitário de Santa Maria/CHLN, CAML, CCUL,Faculdade de Medicina, Universidade de Lisboa, Cardiology - Lisbon - Portugal
European Heart Journal Supplement
Purpose: Despite significant advances in the diagnosis and management of most cardiovascular disorders, infectious endocarditis still has a very high mortality. This study aims to evaluate the long-term prognosis of patients admitted due to infectious endocarditis. Methods: We included consecutive patients admitted to the Cardiology department of a university hospital between 2001 and 2015 with a diagnosis of infectious endocarditis, established by the Duke criteria. We collected information on demographic, clinical, laboratory, echocardiographic, and microbiologic parameters and their association with 2 years-mortality rate was determined by Cox regression analysis. Results: One hundred and twenty patients were included (67.5% male; age 65±14 years; follow-up 31.9±38.4 months). The mortality rate within 2 years was 43% (52 patients). Several parameters were associated with long-term prognosis, including: a baseline RCP> 13mg/dL (p=0.007), a baseline NT-proBNP level > 2500 pg/mL (p=0.016), infection of a bioprosthesis (p<0.001), significant dysfunction of prosthesis (p=0.009), the presence of cardiac fistula (p=0.036) and indication for surgery (p=0.037). The occurrence of several complications during hospitalization, such as class IV heart failure (p<0.001), shock (p<0.001), the need for renal replacement therapy (p<0.001) and stroke (p=0.004) also presented a higher mortality rate. On multivariate Cox regression analysis the only independent predictors of mortality within 2 years were the occurrence of shock [hazard ratio (HR)=8.99; 95% CI 3.02-24.31; p<0.001], stroke (HR = 3,04; 95% CI 1.03-6.52, p=0.043) and the presence of surgery’s indication [HR=9.02; 95% CI 2.68-60.11, p=0.001]. On the other hand, patients submitted to valve surgery had a better prognosis presenting a lower mortality within 2 years (p=0.01). Conclusions: In this study, infectious endocarditis presented a high 2 years-mortality rate. Several clinical and laboratory parameters were associated to a higher mortality rate. The occurrence of shock or stroke during hospitalization and the presence of indication for surgery were identified as the only independent predictors of adverse long-term prognosis, while performing valve surgery had a protective effect. Thus, these parameters may be considered to be included in prognostic stratification of patients with infectious endocarditis.
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