The Forensic Perspective of Infectious Endocarditis: A Retrospective Study With Recommendations for the Future.

Area of Science:

• Forensic Pathology
• Infectious Diseases
• Public Health

Background:

• Infectious endocarditis (IE) rates are rising globally, but forensic data is limited.
• Autopsy findings can identify high-risk patient groups for mortality.
• Understanding IE demographics in forensic cases is essential.

Purpose of the Study:

• To analyze deaths due to infectious endocarditis (IE) in a forensic autopsy series.
• To compare forensic IE demographics with existing clinical literature.
• To assess the quality of death certification for IE cases.

Main Methods:

• Retrospective review of all IE deaths with full autopsy (2010-2022).
• Analysis of patient demographics, manner of death, affected valves, and risk factors.
• Evaluation of death certification consistency.

Main Results:

• 29 IE deaths identified; average age 44 years.
• Manners of death: 69% natural, 28% accident (including intoxication), 3% homicide.
• Most affected valves: aortic (62%), tricuspid (28%), mitral (24%).
• Key risk factors: intravenous drug use (48%), chronic ethanolism (21%).
• No sustained increase in IE deaths observed.
• Significant differences from clinical data: younger age, higher substance use prevalence.
• Inconsistent death certification noted, lacking IE risk factors.

Conclusions:

• Forensic IE cases differ from clinical populations, with younger patients and higher substance use rates.
• Current death certification practices for IE are inconsistent and may obscure risk factors.
• Enhanced death certification quality is needed for accurate IE trend detection and research collaboration.