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Outcomes Associated With Infective Endocarditis in Cardiac Intensive Care Unit Patients
Parth S Patel1, Ojasav Sehrawat2, Anas Hashem3
1Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Insights
Infective endocarditis (IE) in cardiac intensive care units has high mortality. Early surgery improves short-term survival, but long-term outcomes for IE patients remain poor.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Cardiac intensive care units (CICUs) manage the most severe IE cases.
- Understanding IE patient characteristics and outcomes in the CICU is crucial for improving care.
Purpose of the Study:
- To investigate the characteristics of patients with infective endocarditis admitted to a cardiac intensive care unit.
- To analyze associations between patient factors, treatment, and outcomes in this high-risk population.
Main Methods:
- Retrospective cohort study of 233 adult patients with confirmed acute IE admitted to the Mayo Clinic CICU (2007-2018).
- Data collected included demographics, clinical factors, laboratory findings, and outcomes.
- Patients were categorized by cardiac surgery status: performed, indicated but declined, or not indicated. Mortality was analyzed using Kaplan-Meier and Cox regression.
Main Results:
- Staphylococcus aureus was the most common organism (42.7%).
- 30-day mortality was 24.9%, predicted by age, illness severity, comorbidities, and critical care needs.
- Declining surgery significantly increased 30-day (60.4%) and 1-year (85.1%) mortality compared to undergoing surgery or having no indication for it.
Conclusions:
- Infective endocarditis in CICU patients carries a high mortality risk.
- Severity scores, comorbidities, and critical care needs are significant predictors of mortality.
- While early surgical intervention improves short-term outcomes, long-term mortality for IE patients remains a significant concern.
Objective:
To investigate associations and characteristics of patients with infective endocarditis (IE) admitted to the cardiac intensive care unit.
Patients And Methods:
Adult patients admitted to the Mayo Clinic cardiac intensive care unit from January 1, 2007, through April 30, 2018, with confirmed acute IE were included. We conducted a retrospective cohort study of data on demographic characteristics, clinical factors, laboratory findings, and outcomes. Patients were categorized by cardiac surgery status: performed, indicated but declined, or not indicated. Primary outcomes were 30-day and 1-year all-cause mortality, analyzed using the Kaplan-Meier method and Cox proportional hazards regression model and adjusted for predictors.
Results:
A total of 233 patients were included. Native valve IE occurred in 104 patients and prosthetic/device-associated IE in 129 patients. Staphylococcus aureus was the most common organism (99 [42.7%]) and was present in most 30-day deaths (42 [72.4%]). Surgical treatment was indicated in 182 patients (78.1%): 129 underwent a surgical procedure, 53 declined, and 51 had no indication for surgical intervention. The 30-day mortality was 24.9% (58 patients), with older age, higher illness severity and comorbidities, and critical care needs as predictors. The 30-day mortality was higher for those declining surgical treatment (60.4%; adjusted hazard ratio [HR], 2.32; P<.021) and lower for those who underwent surgical intervention vs patients with no indication for such treatment (11.9% vs 23.8%; adjusted HR, 0.40; P=.026). The 1-year mortality was 39.9% (93 patients), with higher mortality in patients who declined surgical intervention (85.1%; adjusted HR, 3.94; P<.001) but similar mortality for those who underwent a surgical procedure vs those with no indication for surgical treatment (31.8% vs 29.3%; adjusted HR, 0.92; P=.80).
Conclusion:
Infective endocarditis in cardiac intensive care unit patients is associated with high mortality. Severity scores, comorbidities, and critical care needs were mortality predictors. Early surgical treatment improved short-term outcomes, but long-term mortality remained high.
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