Variables associated with diagnostic delay and mortality in infective endocarditis: an observational retrospective...

Area of Science:

• Cardiology
• Infectious Diseases
• Clinical Medicine

Background:

• Prompt diagnosis and treatment of infective endocarditis (IE) are crucial for better patient outcomes.
• Diagnostic delays in IE are common but under-investigated, hindering efforts to improve patient survival.
• This study investigates factors associated with delayed IE diagnosis and in-hospital mortality.

Purpose of the Study:

• To identify variables linked to delayed diagnosis in infective endocarditis (IE).
• To examine factors associated with in-hospital mortality in IE patients.
• To understand the impact of fever presentation on IE diagnosis timelines and outcomes.

Main Methods:

• A single-centre retrospective observational study included 349 adult IE episodes (2009-2022) diagnosed by Duke's criteria.
• IE diagnoses within 5 days (<5d) were compared to those on day 5 or later (≥5d).
• Logistic regression and Cox analyses identified factors associated with delayed diagnosis (≥5d) and mortality, with sensitivity analyses performed.

Main Results:

• Of 349 IE episodes, 196 (56.2%) were diagnosed <5d and 153 (43.8%) ≥5d.
• Absence of fever at presentation was significantly associated with delayed diagnosis (OR: 2.09; p=0.011).
• While delayed diagnosis did not impact mortality (HR: 0.96; p=0.905), absence of fever (HR: 2.03; p=0.033) and embolic events (HR: 2.15; p=0.023) increased mortality risk.

Conclusions:

• Patients with infective endocarditis presenting without fever face a higher risk of delayed diagnosis.
• The increased incidence of embolic events in afebrile IE patients may contribute to both diagnostic delays and mortality.
• Targeted strategies to enhance early diagnosis in afebrile IE patients are essential.