ICU-specific determinants of mortality in critically ill patients with infective endocarditis : Mortality predictors

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Dilek Kuzukiran Kocatas1, Behiye Deniz Kosovali2, Nevzat Mehmet Mutlu2

  • 1Department of Intensive Care Medicine, Ankara Bilkent City Hospital, Ankara, Türkiye, Turkey. drdilek06@hotmail.com.

BMC Infectious Diseases
|May 20, 2026
PubMed

Insights

Infective endocarditis (IE) in the ICU has high mortality. Key predictors include neurological status (Glasgow Coma Scale), nutritional risk (NRS), fungal cause, and coronary artery disease, guiding early risk stratification.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Infective endocarditis (IE) presents a significant challenge with high morbidity and mortality, particularly in intensive care unit (ICU) patients.
  • Despite advances, critically ill IE patients face elevated mortality rates, necessitating early identification of prognostic factors.
  • Optimizing management through early predictor identification is crucial for improving outcomes in severe IE cases.

Purpose of the Study:

  • To identify clinical and laboratory predictors of mortality in intensive care unit (ICU) patients with infective endocarditis (IE).
  • To evaluate the predictive performance of severity scores like APACHE II and Glasgow Coma Scale (GCS) in this population.
  • To inform early risk stratification and enhance multidisciplinary management strategies for critically ill IE patients.

Main Methods:

  • Retrospective cohort study of 59 adult IE patients admitted to the ICU.
  • Analysis of demographic data, comorbidities, microbiological findings, clinical severity scores, and laboratory parameters at ICU admission.
  • Utilized Receiver Operating Characteristic (ROC) curve analysis, multivariable logistic regression, and Cox proportional hazards regression for mortality prediction and validation.

Main Results:

  • Overall in-ICU mortality was 52.5%.
  • Independent predictors of mortality included lower GCS score, coronary artery disease, fungal etiology, and higher Nutritional Risk Screening (NRS) score.
  • Factors associated with increased mortality hazard during ICU follow-up included septic embolism, coronary artery disease, elevated total bilirubin, increased creatinine, elevated lactate dehydrogenase, and lower albumin levels.

Conclusions:

  • Mortality in critically ill IE patients remains high, underscoring the need for effective prognostic tools.
  • Neurological status (GCS), nutritional risk (NRS), fungal etiology, and coronary artery disease are key determinants of mortality risk.
  • Findings emphasize the importance of early risk stratification and tailored ICU management to improve outcomes for this high-risk patient group.
Abstract

Keywords:
Critical illnessFungal infective endocarditisInfective endocarditisIntensive care unitMortality predictorsSeptic embolism

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