Outcome of Infective Endocarditis: Improved Results over 18 Years (1990-2007)

Background High morbidity and mortality characterize patients suffering infective endocarditis (IE). The treatment of IE has undergone significant changes within ten years but it is not known whether mortality has decreased and which factors are determinant of the outcome. Objectives Our aim was to evaluate the prognostic significance of clinical characteristics and outcomes of IE. Methods and Results 312 definite cases of IE diagnosed using the Duke criteria were evaluated. Overall in-hospital mortality was 28%. Independent predictors of death, determined by a Weibull regression model, in medically-treated patients were (1) treatment era 1990-1995 vs. 2005-2007 (hazard ratio 3.14; 95% CI 1.37-7.21); (2) aging for each year (hazard ratio 1.02; 95% CI 1.004-1.03); (3) cardiac complications (hazard ratio 1.91; 95% CI 1.06-3.43); and (4) heart failure (hazard ratio 2.27; 95% CI 1.34-3.85). Independent predictors of the death in surgically-treated patients were (1) treatment era 2001-2004 vs. 2005-2007 (hazard ratio: 0.31; 95% CI 0.10-0.97), (2) aging for each year (hazard ratio: 0.96; 95% CI 0.94-0.99), and (3) cardiac complications (hazard ratio: 1.91; 95% CI 1.01-3.63). Conclusions Some of the predictive factors for a poor prognosis were the same as those observed in previous studies. These factors could be used to identify those patients for more aggressive treatment. A new finding was the hazard function for mortality being highest at enrollment and declining rapidly in both medically and surgically treated patients, especially during the first 12 months

Current features of infective endocarditis with microbiologically-negative Blood cultures.

Abs #03

One-year outcome following biological or mechanical valve replacement for infective endocarditis.

International audienceBackground : Nearly half of patients require cardiac surgery during the acute phase of infective endocarditis (IE). We describe the characteristics of patients according to the type of valve replacement (mechanical or biological), and examine whether the type of prosthesis was associated with in-hospital and 1-year mortality.Methods and results : Among 5591 patients included in the International Collaboration on Endocarditis Prospective Cohort Study, 1467 patients with definite IE were operated on during the active phase and had a biological (37%) or mechanical (63%) valve replacement.Patients who received bioprostheses were older (62 vs 54 years), more often had a history of cancer (9% vs 6%), and had moderate or severe renal disease (9% vs 4%); proportion of health care-associated IE was higher (26% vs 17%); intracardiac abscesses were more frequent (30% vs 23%). In-hospital and 1-year death rates were higher in the bioprosthesis group, 20.5% vs 14.0% (p = 0.0009) and 25.3% vs 16.6% (p < .0001), respectively.In multivariable analysis, mechanical prostheses were less commonly implanted in older patients (odds ratio: 0.64 for every 10 years), and in patients with a history of cancer (0.72), but were more commonly implanted in mitral position (1.60).Bioprosthesis was independently associated with 1-year mortality (hazard ratio: 1.298).Conclusions :Patients with IE who receive a biological valve replacement have significant differences in clinical characteristics compared to patients who receive a mechanical prosthesis. Biological valve replacement is independently associated with a higher in-hospital and 1-year mortality, a result which is possibly related to patient characteristics rather than valve dysfunction

Revisiting the effect of referral bias on the clinical spectrum of infective endocarditis in adults.

International audienceReferral bias occurs because of the clustering of patients at tertiary care centers. This may result in the distortion of observed clinical manifestations of rare diseases. This analysis evaluates the effect of referral bias on the epidemiology of infective endocarditis (IE) in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS). This is a prospective multicenter cohort study comparing transferred and non-transferred patients with IE. Factors independently associated with transfer status were evaluated using multivariable logistic regression. A total of 2,760 patients were included in the analysis, of which 1,164 (42.2%) were transferred from other medical centers. Transferred patients more often underwent surgery for IE (odds ratio [OR] = 2.5; 95% confidence interval [CI] 1.9-3.2). They were also more likely to have complications such as stroke (OR = 1.5; 95% CI 1.3-1.9), heart failure (OR = 1.4; 95% CI 1.1-1.6), and new valvular regurgitation (OR = 1.3; 95% CI 1.1-1.6). The in-hospital mortality rates were similar in both groups. Patients with IE who require surgery and suffer complications are referred to tertiary hospitals more frequently than patients with an uncomplicated course. Hospital transfer has no obvious effect on the in-hospital mortality. Referral bias should be taken into consideration when describing the clinical spectrum of IE