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Association Between Cardiac Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Sepsis

Vladimir Krajinovic1, Stipe Ivancic2, Petar Gezman3

  • 1University Hospital for Infectious Diseases "Dr. Fran Mihaljevic," Zagreb, Croatia.

Shock (Augusta, Ga.)
|October 10, 2017
PubMed

Insights

Sepsis and septic shock worsen outcomes for infective endocarditis (IE) patients. However, cardiac surgery improves survival rates for IE patients experiencing sepsis or septic shock.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Infective endocarditis (IE) frequently presents with sepsis or septic shock.
  • Limited data exists on the clinical characteristics and outcomes of IE patients with sepsis.
  • The impact of cardiac surgery on IE outcomes, particularly in sepsis, requires further investigation.

Purpose of the Study:

  • To determine the influence of cardiac surgery on outcomes in patients with IE.
  • To stratify outcomes based on sepsis severity using Sepsis-3 definitions.
  • To analyze the association between surgical treatment and mortality in IE patients with sepsis.

Main Methods:

  • Prospective evaluation of 294 patients with definite IE (native or prosthetic valve) from 2000-2011.
  • Multivariable logistic regression analysis to assess clinical characteristics and outcomes.
  • Stratification by sepsis severity (Sepsis-3 definitions) and treatment (surgical vs. medical).

Main Results:

  • Sepsis and septic shock significantly increased in-hospital mortality in IE patients (OR 8.915 and 35.969, respectively).
  • Cardiac surgery positively influenced in-hospital mortality for IE patients with sepsis or septic shock (OR 5.157).
  • Surgical treatment also improved 1-year survival in this cohort (HR 3.092).

Conclusions:

  • Sepsis and septic shock, per Sepsis-3 definitions, are linked to adverse outcomes in IE.
  • Cardiac surgery demonstrates a beneficial effect on both in-hospital mortality and 1-year survival for IE patients with sepsis or septic shock.
Abstract

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