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Infective endocarditis complicated by shock: a systematic review and meta-analysis.
Roxana-Bianca Pîrîianu-Masgras1, Alexandre Mebazaa2,3, Gianluigi Savarese4
1University of Medicine and Pharmacy Carol Davila, 8 Eroii Sanitari Blvd, 050474, Bucharest, Romania. roxana-bianca.masgras@drd.umfcd.ro.
Heart Failure Reviews
|August 30, 2025
Summary
Infective endocarditis with shock has over 60% mortality. Early valve surgery and prompt treatment significantly improve outcomes for these critically ill patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) complicated by septic or cardiogenic shock presents a severe clinical challenge.
- Shock significantly increases morbidity and mortality rates in IE patients.
Purpose of the Study:
- To evaluate clinical outcomes in IE patients with shock.
- To identify prognostic factors associated with IE and shock.
- To assess the impact of valve surgical intervention on mortality.
Main Methods:
- Systematic review and meta-analysis of observational studies (January 2015 - May 2025).
- Searches conducted in PubMed, Cochrane Library, and Google Scholar adhering to PRISMA and MOOSE guidelines.
- Random-effects model (REML with Hartung-Knapp adjustment) and meta-regression used for data synthesis.
Main Results:
- Pooled in-hospital mortality for IE with shock was 62.3%.
- IE with shock showed a 5.83-fold increased odds of in-hospital mortality compared to IE without shock.
- Valve surgery was linked to reduced mortality, especially in cardiogenic shock. Common complications included acute kidney injury and multiorgan dysfunction.
Conclusions:
- Infective endocarditis complicated by shock carries an extremely high mortality risk.
- Prompt diagnosis, antimicrobial therapy, hemodynamic support, and early valve surgery are critical for improving survival.
- Staphylococcus aureus was a frequent pathogen; multiorgan dysfunction is common.
Keywords:
Cardiogenic shockClinical outcomesInfective endocarditisMortalitySeptic shockSystematic reviewMore Related Videos
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