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Incidence of infective endocarditis and its thromboembolic complications in a pediatric population over 30years
K Thom1, A Hanslik2, J L Russell3
1Pediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada; Division of Pediatric Cardiology, Department of Children and Adolescent Medicine, Medical University Vienna, Austria.
Insights
Pediatric infective endocarditis (IE) is increasingly seen in older children, with rising thromboembolic complications (TEC). Vegetations and heart failure significantly increase mortality risk in these young patients.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pediatric infective endocarditis (IE) presents significant morbidity and mortality, primarily due to thromboembolic complications (TEC).
- Understanding trends in pediatric IE is crucial for improving patient outcomes.
Purpose of the Study:
- To describe the clinical experience of pediatric infective endocarditis (IE).
- To analyze changes in IE origin, vegetation incidence, TEC, and associated mortality over three decades.
Main Methods:
- Retrospective chart review of pediatric patients (0-18 years) diagnosed with IE using Duke Criteria.
- Data analysis divided into three 20-year periods: 1979-1988, 1989-1998, and 1999-2008.
Main Results:
- 113 patients were included; 84% had congenital heart defects.
- Vegetations were present in 60% of patients, with large vegetations (≥1cm) in 28%.
- 40% of patients experienced TEC (20% cerebrovascular events, 20% non-CVE); mortality was 15%, with vegetations and heart failure as significant risk factors.
Conclusions:
- Community-acquired pediatric IE is increasing in older children, alongside a rising incidence of TEC.
- Vegetations and heart failure are key predictors of mortality in pediatric IE.
- Prospective studies are needed to validate these findings.
Background:
Pediatric infective endocarditis (IE) has been associated with high morbidity and mortality, mostly related to thromboembolic complications (TEC). The objective of our study was to describe the experience in children with IE and to review the changes over a thirty-year period, regarding origin of IE, incidence of vegetations, TEC and their respective morbidity and mortality rates.
Methods:
A retrospective chart review of children aged 0-18years with IE defined by the Duke Criteria and admitted to The Hospital for Sick Children, was conducted. Data were divided into three periods (P); P1 (1979-1988); P2 (1989-1998); and P3 (1999-2008).
Results:
The study included 113 patients, median age 7yrs.; females: 46 (41%), congenital heart defects 95 (84%), comparable in all periods. Overall, cardiac vegetations were found in 68/113 patients (60%); large vegetations (≥1cm) in 32 patients (28%). Fourty-five (45/133 [40%]) TEC were documented, 22 patients (20%) developed cerebrovascular events (CVE) and 23 patients (20%) had non-CVE. Patients diagnosed during P3 were older, had more vegetations (p<0.05), and a higher incidence of community acquired-IE (p<0.05). Overall, mortality was 15%, comparable in all periods. Significant risk factors for mortality were vegetations (HR 6.44; 95% CI: 2.07-20.01, p=0.002) and heart failure (HR 28.39; 95% CI: 10.49-76.85, p<0.001).
Conclusions:
Over the study period, we report a growing incidence of community acquired pediatric IE in older children accompanied by an increasing rate of TEC. Heart failure and vegetations were associated with an increased mortality. These preliminary data need to be confirmed by prospective data.
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