Infective endocarditis complicated by shock: a systematic review and meta-analysis

Infective endocarditis (IE) complicated by septic or cardiogenic shock is linked to a marked increase in morbidity and mortality rates. This systematic review and meta-analysis sought to evaluate clinical outcomes, identify prognostic factors, and assess the effects of valve surgical intervention in patients with infective endocarditis complicated by shock. Systematic searches were performed in PubMed, Cochrane Library, and Google Scholar databases, following PRISMA and MOOSE guidelines. Included were observational studies published from January 2015 to May 2025 that reported on adult patients with infective endocarditis complicated by septic or cardiogenic shock. A random-effects model was utilized for data synthesis (restricted maximum likelihood with Hartung-Knapp adjustment), and meta-regression was conducted to assess sources of heterogeneity. Seven observational studies were included (n = 183-255,838). In-hospital mortality among patients with shock was 62.3% (95% CI 48.3-74.5%). Compared with IE without shock, the pooled odds ratio for in-hospital mortality (HK-REML) was 5.83 (95% CI 1.35-25.23; 95% prediction interval 0.26-129.69), with substantial heterogeneity (I² = 90.3%). Valve surgical intervention was associated with reduced mortality, particularly in cardiogenic shock. Staphylococcus aureus was the most common pathogen in available microbiological data. Shock was frequently accompanied by acute kidney injury, neurological complications, and multiorgan dysfunction. Infective endocarditis complicated by shock carries an extremely poor prognosis, with pooled mortality exceeding 60%. Prompt recognition of shock, timely initiation of appropriate antimicrobial therapy, hemodynamic stabilization, and early valve surgery are crucial to improve outcomes in this high-risk population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD420250652570.