Cor Vasa 2019, 61(4):e386-e395 | DOI: 10.33678/cor.2019.036

(Infective endocarditis in a cardiovascular centre with no cardiac surgery unit: epidemiological changes and mortality predictors)

Petr Coufal^a, Jan Večeřa^b, Jan Matějka^a, Jiří Vondrák^a, Martin Kubrycht^a, Petr Vojtíšek^a

^a Kardiologické oddělení, Interní klinika, Pardubická nemocnice, Nemocnice Pardubického kraje, a.s., Pardubice

^b Pracoviště invazivní arytmologie, Kardiologické centrum Agel a.s., Pardubice

Aim: To evaluate the prognosis and changes in the spectrum of patients with infective endocarditis (IE) in a cardiovascular centre with no cardiac surgery unit and to identify predictors of mortality.

Patients and methods: A retrospective analysis was used to identify 147 patients meeting the Duke criteria for infective endocarditis who were hospitalised in the Cardiology Unit of the Pardubice Regional Hospital from 2000 till 2016. This interval has been divided in two time periods and the profiles of patients in each one were compared. To identify predictors of mortality, we used Cox regression analysis and constructed Kaplan-Meier survival curves.

Results: A total of 84 patients (57%) had native valve endocarditis (NVE), 35 (24%) had prosthetic valve endocarditis (PVE), and 28 (19%) had a cardiac device related infective endocarditis (CDRIE). When comparing the periods 2000-2008 and 2009-2016, there was a 126% increase in the number of infective endocarditis patients, while the average age increased by 4 years. The prevalence of comorbidities and IE predispositions increased as well. We found a relative reduction (27%) in NVE cases and an increase in the number of pa- tients with PVE and CDRIE (9% and 18%, respectively). We did not find any statistically significant difference in endocarditis location, type, or causative microbiological agent. Staphylococci (Staphylococcus aureus + coagulase negative Staphylococci [CoNS]) caused 43% (n = 63) of IE cases, Streptococci caused 18% (n = 26) of cases, and Enterococci 8% (n = 10) of cases. At least one complication was reported in 107 (73%) cases. A combination of antibiotics and surgical therapy was needed in 37% of patients, of whom 63% required urgent surgery. There was a significant increase (16%) in in-hospital mortality. We identified the following as IE mortality predictors: advanced age, heart failure, diabetes mellitus, acute kidney injury, sepsis, perivalvular spread of the infection, multiple-organ failure, and emergency cardio-surgical procedure on circulatory or mechanical ventilation support. We also documented increased mortality in patients with PVE (median survival of 2.9 years)., Conclusion: This retrospective study presents the results of the treatment of patients with infective endocarditis from a cardiology centre with no cardiac surgery unit. Comparing two time periods, 2000-2008 and 2009-2016, we have documented a significant increase in the incidence rate of this disease, especially in PVE and CDRIE, and a relative reduction in NVE. The major etiological cause was Staphylococci. We have also documented significantly increased mortality in patients with PVE and an overall increase in hospital mortality. Univariant analysis has demonstrated the typical predictors of mortality. In addition, comorbidities were also found in NVE only.

Keywords: Endocarditis, Epidemiology, Mortality, Native valve endocarditis, Predictors, Prosthetic valve endocarditis

Published: August 11, 2019  Show citation