Frailty predicts in-hospital and 1-year outcomes in patients with infective endocarditis

Infective endocarditis (IE) is a rare but potentially lethal disease. Frailty is a prognostic factor in several clinical settings. However, data on IE remain limited. This study aimed to assess the prevalence of prefrailty and frailty in patients with IE, and their association with in-hospital and 1-year postdischarge outcomes.

This prospective observational study included 197 patients with IE from two referral centres. Frailty was assessed using the FRAIL scale (which evaluates Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight), categorizing patients as robust, prefrail, and frail. Outcomes included acute heart failure (AHF), in-hospital and 1-year mortality, and rehospitalization. Associations were estimated by logistic regression for all outcomes except 1-year mortality, which was analysed using Cox regression. The FRAIL score's additional value was evaluated by receiver operating characteristic curve analysis.

Prefrailty and frailty were present in 71 (36%) and 47 (24%) patients, respectively. Enterococci and coagulase-negative staphylococci were the most frequently isolated microorganisms among frail patients (21% each). Despite surgical indication, frail patients more often received conservative management (16 [34%]) than robust (5 [6%]) and prefrail patients (15 [21%]). The incidence of AHF increased with frailty, as did in-hospital mortality (robust, 10 [13%]; prefrail, 21 [30%]; frail, 18 [38%]; and p 0.003). The FRAIL score independently predicted AHF (OR, 1.60; 95% CI, 1.23-2.08; per point), in-hospital mortality (OR, 1.73; 95% CI, 1.25-2.40), all-cause rehospitalization (OR, 1.54; 95% CI, 1.14-2.08), and 1-year mortality (HR, 1.74; 95% CI, 1.19-2.54). The addition of the FRAIL score provided incremental value to all prediction models, significantly improving discrimination for AHF (area under the curve +0.05, p 0.030) and 12-month rehospitalization (area under the curve +0.06, p 0.016).

Prefrailty and frailty were prevalent in IE patients and were associated with worse outcomes. The FRAIL scale is a valuable prognostic tool to improve risk stratification and optimize short- and medium-term management strategies.