infective endocarditis - what contributes to a bad outcome?

The diagnosis and treatment of infective endocarditis is a major challenge. The clinical course depends on the causative agent, the presence or absence of previous cardiac disease, artificial valves or implantable intracardiac devices, and the mode of presentation.

To determine the 30-day mortality rate in patients with infective endocarditis.

Determine the mortality rate of patients after one year from the diagnosis of infective endocarditis.

Statistical analysis is used to assess the correlation between the characteristics of patients determined at admission and 30-day, i.e. mortality one year after diagnosis.

Determine the clinical significance of the results obtained in the diagnosis and treatment of patients with infective endocarditis.

A prospective study analyzed patients with infective endocarditis treated between 2017 and 2023. The study included 59 patients with infective endocarditis with an average age of 62.4 ± 16.0 years, the representation of the male sex was twice as high. A total of 18 patients had artificial valves, of which 18 had an aortic valve, and two had an aortic and mitral prosthetic valve, 10 patients had a previously implanted pacemaker.

In 19 patients, there was a fatal outcome after one month, with a mortality rate of 32%, and after one year, the fatal outcome occurred in 32 patients, with a mortality rate of 59%.

Predisposing factors independently associated with a higher probability of death after the one-month period were heart failure as a complication of infective endocarditis (OR = 0.025, 95% CI OR = 0.01-0.26, p = 0.002) and a higher number of days of hospitalization (OR = 1.160, 95% CI OR = 1.05-1.28, p = 0.003).

Predictors of death one year after diagnosis were the age of the patient, the presence of a congenital bicuspid aortic valve, uncontrolled infection and heart failure as complications of infective endocarditis, as well as a number of days until the ventilator. Independent predictors of one-year mortality were the presence of bicuspid aortic valve (OR = 33,500.95% CI OR = 1.26-887.90, p = 0.036) and a higher number of days to ventilator (OR = 0.536.95% CI OR = 0.32-0.90, p = 0.018).

An increased mortality rate in patients with infective endocarditis was present in those who had previously been highly febrile for a long period of time due to untimely diagnosis and subsequent treatment, in the elderly population, most likely due to a large number of comorbidities, then in patients with congenital heart defects, in those with previously implanted artificial valves or intracardiac electronic devices.

Factors associated with one-month death