The Clinical Course of Infective Endocarditis and Independent Predictors of In-Hospital Mortality

Abstract

Introduction: Despite advances in prevention, medical, and surgical treatment, the global prevalence of infective endocarditis (IE) has been gradually rising over the last two decades. However, the profile of IE varies by continent, geographic region, and hospital type. In this study, we aimed to investigate the epidemiological and clinical features of IE and to determine the factors predicting in-hospital mortality. Patients and Methods: This retrospective study was carried out at a single tertiary health care hospital in Türkiye. A total of 104 consecutive patients (>18 years old) who were hospitalized with IE between January 2016 and August 2021 were included. Modified Duke criteria were used to diagnose IE. Demographic information (age and gender), underlying heart diseases, comorbidities, causative microorganisms, blood culture results, echocardiographic findings, cardiac and extracardiac complications, surgical requirements, and in-hospital mortality were all examined. Results: The study included 104 IE cases (mean age: 57.2 ± 15.9 years; 59.6% males). Fifty-six patients (53.9%) had native valve IE, 37 patients (35.6%) had prosthetic valve IE, and four patients (3.8%) had devicerelated IE. Blood cultures were negative in 62 cases (59.6%). Staphylococcus aureus was the most common responsible microorganism in 17 patients [methicillin-sensitive Staphylococcus aureus in 13 (12.5%), methicillin-resistant Staphylococcus in four (3.8%)]. The overall in-hospital mortality rate was 30.8%. White blood cell count (OR= 1.002, 95% CI= 1.001-1.003) creatinine (OR= 1.45, 95% CI= 1.08-2.00), acute renal failure (OR= 8.60, 95% CI= 2.27-37.81), and cerebrovascular accidents (OR= 4.58, 95% CI= 1.21-18.85) were independent predictors of in-hospital mortality. Conclusion: In line with developed countries, the epidemiology and causative pathogens of IE in Türkiye have been changing. Investigating these epidemiological and clinical changes may serve as a basis for strategies to be developed for the prevention and treatment of IE.

Keywords

• Infective endocarditis
• microbiology
• epidemiology
• mortality

References

1. 1. Thuny F, Grisoli D, Cautela J, Riberi A, Raoult D, Habib G. Infective endocarditis: Prevention, diagnosis, and management. Can J Cardiol 2014;30(9):1046-57. [Crossref]
2. 2. Khan MZ, Munir MB, Khan MU, Khan SU, Vasudevan A, Balla S. Contemporary trends and outcomes of prosthetic valve infective endocarditis in the United States: Insights from the nationwide inpatient sample. Am J Med Sci 2021;362(5):472-79. [Crossref]
3. 3. Olmos C, Vilacosta I, Fernández-Pérez C, Bernal JL, Ferrera C, García-Arribas D, et al. The evolving nature of infective endocarditis in Spain: A population-based study (2003 to 2014) J Am Coll Cardiol 2017;70:2795-804. [Crossref]
4. 4. Keller K, Von Bardeleben RS, Ostad MA, Hobohm L, Munzel T, Konstantinides S, et al. Temporal trends in the prevalence of infective endocarditis in Germany between 2005 and 2014. Am J Cardiol 2017;119:317-22. [Crossref]
5. 5. Murdoch DR, Corey GR, Hoen B, Miro’ JM, Fowler Jr VG, Bayer AS, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century. The international collaboration on endocarditis-prospective cohort study. Arch Intern Med 2009;169:463-73. [Crossref]
6. 6. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 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). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36(44):3075-128. [Crossref]
7. 7. Østergaard L, Valeur N, Ihlemann N, Bundgaard H, Gislason G, Torp-Pedersen C, et al. Incidence of infective endocarditis among patients considered at high risk. Eur Heart J 2018;39:623-29. [Crossref]
8. 8. Agca FV, Demircan N, Peker T, Ari H, Karaagac K, Ozluk OA, et al. Infective endocarditis: A tertiary referral centre experience from Turkey. Int J Clin Exp Med 2015;8(8):13962-968.

9. 9. Leblebicioglu H, Yilmaz H, Tasova Y, Alp E, Saba R, Caylan R, et al. Characteristics and analysis of risk factors for mortality in infective endocarditis. Eur J Epidemiol 2006;21(1):25-31. [Crossref]
10. 10. Talha KM, Baddour LM, Thornhill MH, Arshad V, Tariq W, Tleyjeh IM, et al. Escalating incidence of infective endocarditis in Europe in the 21st century. Open Heart 2021;8(2):e001846. [Crossref]
11. 11. Cetinkaya Y, Akova M, Akalin HE, Aşçioğlu S, Hayran M, Uzuns O, et al. A retrospective review of 228 episodes of infective endocarditis where rheumatic valvular disease is still common. Int J Antimicrob Agents 2001;18(1):1-7. [Crossref]
12. 12. Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, Pressman GS, et al. Infective endocarditis epidemiology over five decades: A systematic review. PLoS One 2013;8:e82665 [Crossref]
13. 13. Ferraris L, Milazzo L, Rimoldi SG, Mazzali C, Barosi A, Gismondo MR, et al. Epidemiological trends of infective endocarditis in a single center in Italy between 2003-2015. Infect Dis (Lond) 2018;50(10):749-56. [Crossref]
14. 14. Kacmaz AB, Balkan İİ, Sinan UY, Mete B, Saltoglu N, Tabak F, et al. Epidemiological, clinical, and prognostic features of infective endocarditis: A retrospective study with 90 episodes. Cerrahpaşa Med J 2021;45(2):107-15. [Crossref]
15. 15. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, Rybak MJ, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications. Circulation 2015;132:1435-86. [Crossref]
16. 16. Vogkou CT, Vlachogiannis NI, Palaiodimos L, Kousoulis AA. The causative agents in infective endocarditis: A systematic review comprising 33,214 cases. Eur J Clin Microbiol Infect Dis 2016;35(8):1227-45. [Crossref]
17. 17. Buchholtz K, Larsen CT, Hassager C, Bruun NE. In infectious endocarditis patients mortality is highly related to kidney function at time of diagnosis: A prospective observational cohort study of 231 cases. Eur J Intern Med 2009;20(4):407-10. [Crossref]
18. 18. Di Salvo G, Habib G, Pergola V, Avierinos JF, Philip E, Casalta JP, et al. Echocardiography predicts embolic events in infective endocarditis. J Am Coll Cardiol 2001;37(4):1069-76. [Crossref]
19. 19. Thuny F, Di Salvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, et al. Risk of embolism and death in infective endocarditis: Prognostic value of echocardiography: A prospective multicenter study. Circulation 2005;112(1):69-75. [Crossref]
20. 20. Duval X, Iung B, Klein I, Brochet E, Thabut G, Arnoult F, et al. Effect of early cerebral magnetic resonance imaging on clinical decisions in infective endocarditis: A prospective study. Ann Intern Med 2010;152(8):497-W175. [Crossref]
21. 21. Prendergast BD, Tornos P. Surgery for infective endocarditis: Who and when? Circulation 2010;121:1141-52. [Crossref]
22. 22. Şimşek-Yavuz S, Şensoy A, Kaşıkçıoğlu H, Çeken S, Deniz D, Yavuz A, et al. Infective endocarditis in Turkey: Aetiology, clinical features, and analysis of risk factors for mortality in 325 cases. Int J Infect Dis 2015;30:106-14. [Crossref]
23. 23. Zencirkiran Agus H, Kahraman S, Arslan C, Babur Guler G, Kalkan AK, Panc C, et al. Characterization, epidemiological profile and risk factors for clinical outcome of infective endocarditis from a tertiary care centre in Turkey. Infect Dis (Lond) 2019;51(10):738-44. [Crossref]
24. 24. Delahaye F, Alla F, Béguinot I, Bruneval P, Doco-Lecompte T, Lacassin F, et al. In-hospital mortality of infective endocarditis: Prognostic factors and evolution over an 8-year period. Scand J Infect Dis 2007;39(10):849-57. [Crossref]
25. 25. Olmos C, Vilacosta I, Fernández C, López J, Sarriá C, Ferrera C, et al. Contemporary epidemiology and prognosis of septic shock in infective endocarditis. Eur Heart J 2013;34:1999-2006. [Crossref]
26. 26. Ahtela E, Oksi J, Porela P, Ekström T, Rautava P, Kytö V. Trends in occurrence and 30-day mortality of infective endocarditis in adults: Population-based registry study in Finland. BMJ Open 2019;9(4):e026811. [Crossref]