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

In infective endocarditis (IE), a prompt diagnosis and therapy lead to better outcomes. Diagnostic delay seems common, but causing factors are still under-investigated, limiting actions to improve outcomes. This study examines variables associated with IE delayed diagnosis and mortality.

This single-centre retrospective observational study included adults diagnosed with IE according to Duke's criteria from 2009 to 2022. IE diagnoses within 5 days from hospital admission (<5d) were compared to those from day 5 onwards (≥5d). Logistic regression and Cox analyses identified factors associated with ≥5d diagnosis and in-hospital mortality. Sensitivity analyses excluding recurrent endocarditis or diagnoses before 2016, and a post-hoc analysis focused on fever at admission were performed.

This study included 349 episodes of IE that occurred in 331 patients (females:31.2%; median age:72 years). Median time to diagnosis was 3 days (IQR:1-8), 196 (56.2%) patients received a diagnosis before and 153 (43.8%) after 5 days. Absence of fever at presentation was associated with ≥5d diagnosis (OR:2.09; 95%CI [1.23-3.56]; p = 0.011). Although mortality was not associated to a ≥ 5d diagnosis (HR:0.96; 95%CI [0.49-1.87] p = 0.905), a higher risk of mortality was found in patients with absence of fever (HR:2.03; 95%CI [1.06-3.90]; p = 0.033) and embolic events (HR:2.15; 95%CI [1.11-4.16]; p = 0.023), which were more frequent in patients without fever (46/120, 38.3%) than with fever (54/227, 23.8%, p = 0.007).

IE patients presenting without fever have higher risk of delayed diagnosis and mortality, possibly due to a higher incidence of embolic events. In these patients, efforts to improve early diagnosis are required.