Background: Despite the medical progress made in the past decades, infective endocarditis (IE) still remains a disease with a poor prognosis. The aim of this study is to highlight potential predictors of mortality in patients suffering from an IE.
Methods: This was a prospective (January 2018 to June 2022) and retrospective (January 2015 to December 2017) study conducted at a tertiary center (CHUV), in Lausanne, Switzerland. It analyzed the impact of surgery on adult patients who were diagnosed with a left-side definite or possible IE according to modified Duke criteria. IE and indications for valve surgery were defined according to the 2015 ESC guidelines on IE management.
Results: The clinical data of 520 patients diagnosed with IE were analyzed in our study. The all-cause 30-day mortality in our cohort was 13%; 11% (27 episodes out of 251) in patients without surgical indication (Group 1), 44% (27 out of 61) in those with indication that did not undergo valve surgery (Group 2) and 5% (11 out of 208) in those with indication who underwent a valve surgery (Group 3). Multivariate analysis revealed that early mortality was associated with a Charlson Comorbidity Index (CCI) >4 points (OR 1.96, 95% CI 1.13-3.39), S. aureus (OR 1.66, 95% CI 0.95-2.92), acute HF (OR 2.83, 95% CI 1.69-4.78), sepsis (OR 2.10, 95% CI 1.21-3.62), presence of embolic events (OR 1.98, 95% CI 1.12-3.48) and absence of surgical indication (OR 2.32, 95% CI 1.10-4.86) or presence of surgical indication without valve operation (OR 7.57, 95% CI 3.67-15.73) (both compared to presence of surgical indication with valve operation). The overall mortality at 1-year in our cohort was 29%. The multivariate analysis revealed that late mortality was associated with age >60 years old (OR 1.86, 95% CI 1.07-3.26), a CCI >4 (OR 2.06, 95% CI 1.31-3.25), nosocomial IE (OR 1.92, 95% CI 1.29-2.86), S. aureus (OR 1.61, 95% CI 1.10-2.36), HF (OR 1.58, 95% CI 1.08-2.32), sepsis (OR 1.72, 95% CI 1.15-2.57), hemorrhagic stroke (OR 3.01, 95% CI 1.69-5.36), septic arthritis (OR 2.92, 95% CI 1.39-6.15), hospital acquired pneumonia (OR 1.75, 95% CI 1.14-2.68), and absence of surgical indication (OR 1.98, 95% CI 1.23-3.21) or presence of surgical indication without valve operation (OR 4.31, 95% CI 2.55-7.23) (both compared to presence of surgical indication with valve operation).
Conclusion: The absence of surgical management was an important risk factor of short- and long-term mortality in patients suffering from IE.