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Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients

Published:August 31, 2021DOI:https://doi.org/10.1016/j.ejim.2021.08.011

      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)
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