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Infective endocarditis profile, prognostic factors and in-hospital mortality: six-year trends from a tertiary university center in South America
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  • Ana Paula Tagliari,
  • Gabriela Vieira Steckert ,
  • Lucas Molinari Veloso da Silveira ,
  • Adriano Nunes Kochi,
  • Orlando Belmonte Wender
Ana Paula Tagliari
Universidade Federal do Rio Grande do Sul
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Gabriela Vieira Steckert
Universidade Federal do Rio Grande do Sul
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Lucas Molinari Veloso da Silveira
Universidade Federal do Rio Grande do Sul
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Adriano Nunes Kochi
Hospital Nossa Senhora da Conceição
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Orlando Belmonte Wender
Hospital de Clinicas de Porto Alegre
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Abstract

Background: Infective endocarditis (IE) remains an expressive health problem with high morbimortali-ty rates. Despite its importance, epidemiological and microbiological data remain scarce, especially in developing countries. Aim: This study aims to describe IE epidemiological, clinical, and microbiological profile in a tertiary university center in South America, and to identify in-hospital mortality rate and predictors. Methods: Observational, retrospective study of 167 patients, who fulfilled modified Duke’s criteria during a six-year enrollment period, from January 2010 to December 2015. Primary outcome was de-fined as in-hospital mortality analyzed according to treatment received (clinical vs. surgical). Multivari-ate analysis identified mortality predictors. Results: Median age was 60years (Q1-Q3 50-71), and 66% were male. Echocardiogram demonstrated vegetations in 90.4%. An infective agent was identified in 76.6%, being Staphylococcus aureus (19%), Enterococcus (12%), Coagulase-negative staphylococci (10%), and Streptococcus viridans (9.6%) the most prevalent. Overall in-hospital mortality was 41.9%, varying from 49.4% to 34.1%, in clinical and surgical patients, respectively (p=0.047). On multivariate analysis, diabetes mellitus (OR 2.5), previous structural heart disease (OR 3.1), and mitral valve infection (OR 2.1) were all-cause death predictors. Surgical treatment was the only variable related to better outcome (OR 0.45; 95%IC 0.2-0.9). Conclusion: This study presents IE profile and all-cause mortality in a large patient’s cohort, compris-ing a 6-years’ time window, a rare initiative in developing countries. Elderly and male patients predom-inated, while Staphylococcus aureus was the main microbiological agent. Patients conservatively treated presented higher mortality than surgically managed ones. Epidemiological studies from developing countries are essential to increase IE understanding.

Peer review status:ACCEPTED

25 May 2020Submitted to Journal of Cardiac Surgery
26 May 2020Assigned to Editor
26 May 2020Submission Checks Completed
26 May 2020Reviewer(s) Assigned
11 Jun 2020Review(s) Completed, Editorial Evaluation Pending
11 Jun 2020Editorial Decision: Accept