Early Predictors of In-Hospital Death in Infective Endocarditis

TLDR

Early determinants of outcome in infective endocarditis are poorly understood. The study assessed whether early clinical characteristics predict in‑hospital death in a large prospective cohort of IE patients. In 267 consecutive IE patients, acute physiology was quantified with APACHE II and early heart failure diagnosed using Framingham criteria within seven days of presentation. In‑hospital mortality was 19 %; diabetes, Staphylococcus aureus infection, higher APACHE II scores, and embolic events independently predicted death, while early echocardiographic findings were not predictive, suggesting these readily available clinical factors can guide more aggressive treatment.

Abstract

Data on early determinants of outcome in infective endocarditis (IE) are limited. We evaluated the prognostic significance of early clinical characteristics in a large, prospective cohort of patients with IE.Two hundred sixty-seven consecutive patients with definite or possible IE by modified Duke criteria and echocardiography performed within 7 days of presentation were evaluated. Acute physiology was assessed by the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score at the time of presentation, and early heart failure was diagnosed by Framingham criteria. In-hospital mortality rate in the cohort was 19% and similar for patients with definite or possible IE (20% versus 16%, respectively; P=0.464). Independent predictors of death determined by logistic regression modeling were diabetes mellitus (OR 2.48; 95% CI, 1.24 to 4.96), Staphylococcus aureus as causative organism (OR, 2.06; 95% CI, 1.01 to 4.20), APACHE II score (OR, 1.07; 95% CI, 1.01 to 1.12), and embolic event (OR, 2.79; 95% CI, 1.15 to 6.80). Early echocardiographic findings of the Duke criteria were not predictive of death.Early in the course of IE, readily available clinical characteristics that reflect the host-pathogen interaction are predictive of in-hospital death. These factors may identify those patients with IE for more aggressive treatment.