Early and late mortality of adult patients with definite or possible infective endocarditis: a monocentric retro/prospective observational study
Details
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Version: After imprimatur
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UNIL restricted access
State: Public
Version: After imprimatur
License: Not specified
Serval ID
serval:BIB_02CE0A9E4526
Type
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Collection
Publications
Institution
Title
Early and late mortality of adult patients with definite or possible infective endocarditis: a monocentric retro/prospective observational study
Director(s)
MONNEY P.
Codirector(s)
PAPADIMITRIOU OLIVGERIS M.
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2023
Language
english
Number of pages
32
Abstract
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.
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.
Keywords
Infective endocarditis, surgery, prognosis, mortality
Create date
25/07/2024 7:31
Last modification date
26/07/2024 6:03