Infective endocarditis on ICU: risk factors, outcome and long-term follow-up

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Cardiology

Background:

• Infective endocarditis (IE) is a serious infection affecting heart valves.
• Outcomes for critically ill IE patients requiring intensive care unit (ICU) admission are often poor.
• Predictors of survival in this specific high-risk population require further elucidation.

Purpose of the Study:

• To identify factors influencing short-term, intermediate, and long-term outcomes in patients with IE requiring ICU treatment.
• To determine independent predictors of mortality in critically ill IE patients.

Main Methods:

• Retrospective analysis of 216 patients with IE admitted to two medical ICUs between 2002 and 2009.
• Long-term follow-up conducted via questionnaire.
• Multivariate Cox-regression analysis to identify independent risk factors for mortality.

Main Results:

• Mortality on ICU was 24.9%, with an additional 19.9% dying during follow-up.
• High initial and maximum SAPS II scores and multiple organ failure predicted 30-day and 100-day mortality.
• High maximum leukocyte count predicted long-term mortality.
• Surgical intervention during ICU stay was associated with better 30-day outcomes.

Conclusions:

• In critically ill IE patients, biomarkers of acute infection and severity scores (SAPS II) are stronger predictors of mortality than the infectious agent or valve type.
• Surgical intervention is a significant independent predictor of improved 30-day survival.
• Focusing on illness severity and timely surgical management may improve outcomes in this population.