Highlights
- •414 patients with left-sided endocarditis were followed up for a median of 39 months.
- •Cardiovascular disease markers influence infective endocarditis prognosis beyond 1 year.
- •Arterial disease and hyperglycemia at endocarditis onset signal a higher risk of death.
Abstract
Introduction
: Very limited data are available on the long-term outcome of infective endocarditis
(IE) and its determinants. The aim of this study was to identify the predictors of
long-term mortality in patients affected by left sided IE (LSIE).
Methods
: This was an historical retrospective observational study on prospectively collected
data from patients with LSIE hospitalized in our Unit (January 2000-December 2017).
Multiple variables relevant to history, physical examination, laboratory tests, echocardiography,
comorbidities, complications and outcome were analysed by Cox regression to identify
predictors of long-term mortality.
Results
: 414 patients were included, and followed up for a median of 39 months [IQR 11-74].
Median age was 59 years [range 3-89], and most patients were male. Over 50% showed
at least one comorbidity. Hyperglycaemia, increased creatinine and an indication for
surgery predicted in-hospital mortality, while a prior myocardial infarction, chronic
kidney disease (CKD) on hemodialysis and a larger vegetation were independent predictors
of 1-year mortality. At multivariate analysis, peripheral arterial disease (p= 0.017),
hyperglycemia on admission (p=0.013) and a higher BMI (p=0.009) were independent predictors
of long-term mortality in 1-year survivors. At multivariable Cox proportional hazard
regression, peripheral arterial disease (p=0.002), hyperglycemia (p=0.041) and CKD
on hemodialysis (p=0.025) confirmed to be independently associated with an increased
risk of long-term mortality in the overall 414 patient cohort.
Conclusions
: Cardiovascular and metabolic risk signals, specifically peripheral arterial disease
and hyperglicemia, affect long-term mortality of LSIE. An active and long-term follow
up seems warranted in IE survivors showing these conditions at outset.
Keywords
Abbreviations:
(IE) (infective endocarditis), (LSIE) (left sided infective endocarditis), (IQR) (Interquartilezrange), (CKD) (chronic kidney disease), (BMI) (body mass index), (CRF) (case report form), (COPD) (chronic obstructive pulmonary disease), (CCI) (Charlson comorbidity index), (ICD) (implantable cardioverter defibrillator), (CRP) (C-reactive protein), (ESR) (erythrocyte sedimentation rate), (ORs) (Odds Ratios), (CI) (confidence intervals), (SD) (standard deviation)To read this article in full you will need to make a payment
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References
- Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 [published correction appears in Lancet. 2013; 381:628].Lancet. 2012; 380: 2197-2223
- Update on infective endocarditis.Curr Probl Cardiol. 2006; 31 (Apr): 274-352
- Infective endocarditis.Lancet. 2016; 387: 882-893
- Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years.BMC Infect Dis. 2008; 8: 49
- Long-term outcomes in valve replacement surgery for infective endocarditis.Ann Thorac Surg. 2007; 83: 30-35
- Clinical presentation, etiology and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.Arch Intern Med. 2009; 169: 463-473
- Prognostic index in prediction of mortality from infective endocarditis.Int J Cardiol. 1989; 24: 47-54
- Immediate and long-term outcome of left-sided infective endocarditis. A 12-year prospective study from a contemporary cohort in a referral hospital.Clin Microbiol Infect. 2012; 18: E522-E530
- Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study.Eur Heart J. 2007; 28: 196-203
- Excess mortality and morbidity in patients surviving infective endocarditis.Am Heart J. 2012; 164: 94-101
- Long-term outcome of infective endocarditis in non-intravenous drug users.Mayo Clin Proc. 2008; 83: 1213-1217
- Survival of surgically treated infective endocarditis: a comparison with the general Dutch population.Ann Thorac Surg. 2011; 91: 1407-1412
- Long-term causes of death in patients with infective endocarditis who undergo medical therapy only or surgical treatment: a nationwide population-based study.Eur J Cardio-Thoracic Surg. 2018; 54: 860-866
- A nationwide cohort study of mortality risk and long-term prognosis in infective endocarditis in Sweden.PLoS One. 2013; 8: e67519
- Current Epidemiology and Outcome of Infective Endocarditis A Multicenter, Prospective, Cohort Study.Medicine (Baltimore). 2015; 94: e1816
- Infective endocarditis: determinants of long term outcome.Heart. 2002; 88 (Jul;): 61-66
- Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the task force on infective endocarditis of the European society of cardiology.Eur Heart J. 2004; 25 (Feb): 267-276
- ESC Committee for Practice Guidelines. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC).Eur Heart J. 2009; 30: 2369-2413
- 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC).Eur Heart J. 2015; 36: 3075-3128
- Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis.Clin Infect Dis. 2000; 30: 633-638
- Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis.Infection. 2012; 40: 527-535
- Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study.Arch Intern Med. 2008; 168: 2095-2103
- Gersh BJ; the Coronary Artery Surgery Study (CASS) Investigators. Long-term survival in patients with coronary artery disease: importance of peripheral vascular disease.J Am Coll Cardiol. 1994; 23: 1091-1095
- Prevalence and prognostic significance of asymptomatic peripheral arterial disease in 68-year-old men with diabetes: results from the population study “Men Born in 1914” from Malmo, Sweden.Eur J Vasc Endovasc Surg. 2005; 29: 182-189
- Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study.BMJ. 1996; 313: 1440-1444
- Fate in intermittent claudication: outcome and risk factors.BMJ. 1986; 293: 1137-1140
- Northern New England Cardiovascular Disease Study Group. The effect of peripheral vascular disease on in-hospital mortality rates with coronary artery bypass surgery.J Vasc Surg. 1995; 21: 445-452
- Northern New England Cardiovascular Disease Study Group. The effect of peripheral vascular disease on long-term mortality after coronary artery bypass surgery.Arch Surg. 1996; 131: 316-321
- Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level.Atherosclerosis. 2005; 178: 351-357
- Ankle/arm pressure index in asymptomatic middle-aged males: an independent predictor of ten-year coronary heart disease mortality.Angiology. 1995; 46: 211-219
- Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index.JAMA. 1993; 270: 487-489
- Update on some epidemiologic features of intermittent claudication.J Am Geriatr Soc. 1985; 33: 13-18
- Peripheral Arterial Disease. Morbidity and Mortality Implications.Circulation. 2006; 114: 688-699
- Association between blood glucose and long-term mortality in patients with acute coronary syndromes in the OPUS-TIMI 16 trial.Am J Cardiol. 2006; 97: 1573-1577
- Synergistic relationship between hyperglycaemia and inflammation with respect to clinical outcomes in non-ST-elevation acute coronary syndromes: analyses from OPUS-TIMI 16 and TACTICS-TIMI 18.Eur Heart J. 2007; 28: 806-813
- AEPEI Study Group. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey.Clin Infect Dis. 2012; 54: 1230-1239
- Changing patient characteristics and the effect on mortality in endocarditis.Arch Intern Med. 2002; 162: 90-94
- Clinical features of Staphylococcus aureus endocarditis.Arch Intern Med. 1999; 159: 462-469
Article info
Publication history
Published online: August 31, 2021
Accepted:
August 11,
2021
Received in revised form:
July 20,
2021
Received:
April 21,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
