Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.
BACKGROUND: We sought to provide a contemporary picture of the presentation,
etiology, and outcome of infective endocarditis (IE) in a large patient cohort
from multiple locations worldwide.
METHODS: Prospective cohort study of 2781 adults with definite IE who were
admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1,
2005.
RESULTS: The median age of the cohort was 57.9 (interquartile range, 43.2-71.8)
years, and 72.1% had native valve IE. Most patients (77.0%) presented early in
the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent
health care exposure was found in one-quarter of patients. Staphylococcus aureus
was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%)
valves were infected most commonly. The following complications were common:
stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%),
and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and
in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds
ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46
per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection
(1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10),
mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25;
1.64-3.09) were associated with an increased risk of in-hospital death, whereas
viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83)
were associated with a decreased risk.
CONCLUSIONS: In the early 21st century, IE is more often an acute disease,
characterized by a high rate of S aureus infection. Mortality remains relatively
high.
PMID