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Determinants of prognosis in 300 episodes of infective endocarditis
A J Mansur1, M Grinberg, R H Cardoso
1Heart Institute, São Paulo University Medical School, Brazil.
Abstract:
We studied 300 episodes of infective endocarditis in 287 patients to evaluate clinical and laboratory determinants of prognosis by estimating the probability of in-hospital death. The patients' ages ranged from 2 months to 78 (mean 30.76 +/- 16.06) years; 185 (62%) episodes occurred in male and 115 (38%) in female patients. A total of 386 complications occurred in 223 (74%) episodes of endocarditis. The infecting microorganisms were streptococci in 147 episodes, Staphylococcus aureus in 59, Staphylococcus epidermidis in 14, gram-negative bacteria in 16, other gram-positive bacteria in 8, fungi in 4. The causative microorganism was not identified in 52 episodes (negative blood cultures). The underlying cardiac disease was valvular in 119 episodes, congenital in 37, prosthetic heart valve in 69, and others in 6. No previous heart disease was identified in 69 episodes. Surgical treatment was carried out in 102 (34%) patients. Overall, 78 (26%) patients died. The probability of death was estimated with a logistic regression model (stepwise procedure). The model with best prediction included the cardiac status previous to the endocarditis, the causative microorganism, the occurrence of complications, and the blood leukocyte count. The most important variable in predicting in-hospital death was the occurrence of complications, followed by cardiac status (prosthetic valve endocarditis), the infecting microorganism, and leukocyte count. The model underestimated the severity of the disease in patients with acute endocarditis and overestimated in patients with prosthetic valve endocarditis submitted to surgical treatment.
Insights
Complications and cardiac status significantly predict in-hospital death in infective endocarditis (IE). Identifying these factors aids in prognosis for IE patients, guiding treatment strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Prognostics
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves and surfaces.
- Prognosis in IE varies widely, necessitating identification of key predictive factors for in-hospital mortality.
- Understanding determinants of death is crucial for clinical management and resource allocation.
Purpose of the Study:
- To evaluate clinical and laboratory determinants of prognosis in infective endocarditis.
- To estimate the probability of in-hospital death based on various patient and disease characteristics.
- To identify the most significant factors predicting mortality in IE patients.
Main Methods:
- Retrospective analysis of 300 IE episodes in 287 patients.
- Logistic regression modeling (stepwise procedure) to predict in-hospital death.
- Inclusion of variables such as patient demographics, causative microorganisms, cardiac status, complications, and laboratory findings (leukocyte count).
Main Results:
- Overall in-hospital mortality was 26% (78 deaths).
- Key predictors of death identified: occurrence of complications, cardiac status (prosthetic valve endocarditis), infecting microorganism, and leukocyte count.
- Complications were the most significant predictor of in-hospital death.
Conclusions:
- The developed logistic regression model effectively predicts in-hospital mortality in IE.
- Prognostic factors include prior cardiac status, causative agent, complications, and leukocyte count.
- The model's accuracy varied, underestimating risk in acute IE and overestimating in surgically treated prosthetic valve endocarditis.