Clinical predictors of mortality from infective endocarditis

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Abstract

A cohort study with prospective data collection was conducted to determine which risk factors and outcome variables are statistically significant clinical predictors of mortality from infective endocarditis. A study was performed from an eleven-year, hospitalization cohort (N = 11,230) in which the data were collected prospectively. The study examined 21 potential risk factors and 14 outcome variables. The risk factors were categorized into these various groups: patient factors, cardiac factors, co-morbidities, operative factors, infectious factors, and complications. The outcome variables were categorized into operative factors, infectious factors, and complications. Inclusion criteria included patients with endocarditis (N = 87). Longer operative time, operative complications, and postoperative complications. Overall mortality was 11.5 percent (N = 10). Endocarditis patients who died were significantly older (p = 0.023) and had a longer pump time (p = 0.017) than those who survived. Endocarditis patients who died were more likely to experience an unstable hemodynamic status (p = 0.012). There was a significant difference between survival and non-survival of patients with endocarditis on nine outcome variables. They were more likely to require a re-operation for bleeding (p = 0.034). Renal complications (p = 0.016), neurological complications (p = 0.004), pulmonary complications (p = 0.001), intra-operative complications (p = 0.035), and IAPB (p < 0.001) were all more likely to occur in endocarditis patients who died. There are risk factors that serve as predictors of mortality from infectious endocarditis. These include age greater than 65 years, longer pump time, and unstable hemodynamic status. Outcome variables that reflected significant mortality included operative complications and post-operative complications. These factors may identify those patients with infective endocarditis eligible for more aggressive treatment.

Keywords

Infective endocarditis
Mortality
Outcomes
Risk factor
Predictor

Abbreviations

BSA
body surface area
ICU
intensive care unit
IABP
intra-aortic balloon pump
NYHA
New York Heart Association

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The following are the substantial contributions the authors made in the paper: J. Michael Smith MD FACS: conception and design, acquisition of a substantial portion of data, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, supervision (overall responsibility for all aspects of the project or study). Robert R. So MD: interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. Amy M. Engel MA: analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content.