Short-term and one-year outcome of infective endocarditis in adult patients treated in a Finnish teaching hospital during 1980 - 2004

Login or register to view PDF.


Previous studies on factors predicting the prognosis of infective endocarditis have given somewhat conflicting results. Our aim was to define the factors predicting the outcome of patients treated in a Finnish teaching hospital.


A total of 326 episodes of infective endocarditis in 303 patients treated during 1980├óÔé¼ÔÇ£2004 were evaluated for short-term and 1-year outcome and complications.

Infection of 2 native valves and the occurrence of neurological complications, peripheral emboli, or heart failure significantly predicted both in-hospital and 1-year mortality, while age ├óÔÇ░─ä65 years or the presence of a major criterion or vegetation on echocardiography predicted death within 1 year. A significant trend was observed between the level of serum C-reactive protein (CRP) on admission and both the short-term and 1-year outcome. In the patients who had CRP values ├óÔÇ░─ä100 mg/l on admission, the hazard ratio for in-hospital death was 2.9-fold and the hazard ratio for 1-year death was 3.9-fold as compared to those with lower CRP values. Male sex and age < 64 years significantly predicted a need for both in-hospital and 1-year surgery, as did the development of heart failure or the presence of a major criterion or vegetation on echocardiography. Peripheral emboli were associated with a need for in-hospital surgery, while Streptococcus pneumoniae as the causative agent or infection of 2 native valves predicted a need for surgery within 1 year from admission.

Some of the factors (e.g. heart failure, neurological complications, peripheral emboli) predicting a poor prognosis and/or need for surgery were the same observed in previous studies. A new finding was that high CRP values (├óÔÇ░─ä100 mg/l) on admission significantly predicted both short-term and 1-year mortality.

Infective endocarditis is a diagnostic and therapeutic challenge to clinicians. Despite major advances in cardiac imaging technology, antimicrobial treatment and surgical techniques, the morbidity and mortality associated with infective endocarditis remains high. Several previous studies from the 1990's and 2000's show that mortality of endocarditis is still from 10% to 24% [1-6]. Some authors report a decreasing trend in mortality, and this has been attributed either to lower operative mortality [7], or technically more successful early valve surgery [6]. Previous studies have attempted to identify various clinical and microbial factors predicting either short-term or long-term mortality of infective endocarditis, with somewhat conflicting results [5,8-12].


  1. Nissen H, Nielsen PF, Frederiksen M, Helleberg C, Nielsen JS: Native valve infective endocarditis in the general population: a 10- year survey of the clinical picture during the 1980s. Eur Heart J 1992, 13:872-877.
  2. Van der Meer JTM, Thompson J, Valkenburg HA, Michel MF: Epidemiology of bacterial endocarditis in the Netherlands. I. Patient characteristics. Arch Intern Med 1992, 152:1863-1868.
  3. Watanakunakorn C, Burkert T: Infective endocarditis at a large community teaching hospital, 1980├óÔé¼ÔÇ£1990. A review of 210 episodes. Medicine (Baltimore) 1993, 72:90-102.
  4. Delahaye F, Goulet V, Lacassin F, Ecochard R, Selton-Suty C, Hoen B, Etienne J, Brian─é┬ğon S, Leport C: Characteristics of infective endocarditis in France 1991. A 1-year survey. Eur Heart J 1995, 16:394-401.
  5. Netzer ROM, Zollinger E, Seiler C, Cerny A: Infective endocarditis: clinical spectrum, presentation and outcome. An analysis of 212 cases 1980├óÔé¼ÔÇ£1995. Heart 2000, 84:25-30.
  6. Hoen B, Alla F, Selton-Suty C, B─é┬®guinot I, Bouvet A, Brian─é┬ğon S, Casalta JP, Danchin N, Delahaye F, Etienne J, Le Moing V, Leport C, Mainardi JL, Ruimy R, Vandenesch F: Changing profile of infective endocarditis. Results of a 1-year survey in France. JAMA 2002, 288:75-81.
  7. Tornos MP, Olona M, Permanyer-Miralda G, Almirante B, Evangelista A, Soler-Soler J: Is the clinical spectrum and prognosis of native valve infective endocarditis in non-addicts changing? Eur Heart J 1995, 16:1686-1691.
  8. Delahaye F, Ecochard R, de Gevigney G, Barjhoux C, Malquarti V, Saradarian W, Delaye J: The long term prognosis of infective endocarditis. Eur Heart J 1995, 16(Suppl B):48-54.
  9. Cabell CH, Jollis JG, Peterson GE, Corey GR, Anderson DJ, Sexton DJ, Woods CW, Reller LB, Ryan T, Fowler VG: Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 2002, 162:90-94.
  10. Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH: Mortality from infective endocarditis: clinical predictors of outcome. Heart 2002, 88:53-60.
  11. Hasbun R, Vikram HR, Barakat LA, Buenconsejo J, Quagliarello VJ: Complicated left-sided native valve endocarditis in adults. Risk classification for mortality. JAMA 2003, 289:1933-1940.
  12. Chu VH, Cabell CH, Benjamin DK, Kuniholm EF, Fowler VG, Engemann J, Sexton DJ, Corey GR, Wang A: Early predictors of in-hospital death in infective endocarditis. Circulation 2004, 109:1745-1749.
  13. Heiro M, Nikoskelainen J, Hartiala JJ, Saraste MK, Kotilainen PM: Diagnosis of infective endocarditis. Sensitivity of the Duke vs von Reyn criteria. Arch Intern Med 1998, 158:18-24.
  14. Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila RJ, Kotilainen P: Neurologic manifestations of infective endocarditis. A 17-year experience in a teaching hospital in Finland. Arch Intern Med 2000, 160:2781-2787.
  15. Heiro M, Helenius H, Sundell J, Koskinen P, Engblom E, Nikoskelainen J, Kotilainen P: Utility of serum C-reactive protein in assessing the outcome of infective endocarditis. Eur Heart J 2005, 26:1873-1881.
  16. Heiro M, Helenius H, M─é┬ñkil─é┬ñ S, Savunen T, Engblom E, Nikoskelainen J, Kotilainen P: Infective endocarditis in a Finnish teaching hospital. A study on 326 episodes treated during 1980├óÔé¼ÔÇ£2004. Heart 2006, 92:1457-1462.
  17. Durack DT, Lukes AS, Bright DK, the Duke Endocarditis Service: New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 1994, 96:200-209.
  18. Thuny F, Disalvo G, Belliard O, Avierinos JF, Pergola V, Rosenberg V, Casalta JP, Gouvernet J, Derumeaux G, Iarussi D, Ambrosi P, Calabro R, Riberi A, Collart F, Metras D, Lepidi H, Raoult D, Harle JR, Weiller PJ, Cohen A, Habib G: Risk of embolism and death in infective endocarditis: prognostic value of echocardiography. A prospective multicenter study. Circulation 2005, 112:69-75.
  19. Sanabria TJ, Alpert JS, Goldberg R, Pape LA, Cheeseman SH: Increasing frequency of staphylococcal infective endocarditis. Experience at a university hospital, 1981 through 1988. Arch Intern Med 1990, 150:1305-1309.
  20. Fernandez-Guerrero ML, Verdejo C, Azofra J, Azofra J, de Gorgolas M: Hospital-acquired infectious endocarditis not associated with cardiac surgery: an emerging problem. Clin Infect Dis 1995, 20:16-23.
  21. R─é┬©der BL, Wandall DA, Frimodt-M─é┬©ller N, Espersen F, Skinhoj P, Rosdahl VT: Clinical features of Staphylococcus aureus endocarditis: a 10-year experience in Denmark. Arch Intern Med 1999, 159:462-469.
  22. Miro JM, Anguera I, Cabell CH, Chen AY, Stafford JA, Corey GR, Olaison L, Eykyn S, Hoen B, Abrutyn E, Raoult D, Bayer A, Fowler VG Jr, International Collaboration on Endocarditis Merged Database Study Group: Staphylococcus aureus native valve infective endocarditis: Report of 566 episodes from the International Collaboration on endocarditis merged database. Clin Infect Dis 2005, 41:507-514.
  23. Nadji G, R─é┬®madi JP, Coviaux F, Ali Mirode A, Brahim A, Enriquez-Sarano M, Tribouilloy C: Comparison of clinical and morphological characteristics of Staphylococcus aureus endocarditis with endocarditis caused by other pathogens. Heart 2005, 91:932-937.
  24. Aronin SI, Mukherjee SK, West JC, Cooney EL: Review of pneumococcal endocarditis in adults in the penicillin era. Clin Infect Dis 1998, 26:165-171.
  25. Cabell CH, Pond KK, Peterson GE, Durack DT, Corey GR, Anderson DJ, Ryan T, Lukes AS, Sexton DJ: The risk of stroke and death in patients with aortic and mitral valve endocarditis. Am Heart J 2001, 142:75-80.
  26. Martin-D─é╦çvila P, Navas E, Fort─é┼şn J, Moya JL, Cobo J, Pintado V, Quereda C, Jimenez-Mena M, Moreno S: Analysis of mortality and risk factors associated with native valve endocarditis in drug users: The importance of vegetation size. Am Heart J 2005, 150:1099-1106.
  27. Siddiq S, Missri J, Silverman DI: Endocarditis in an urban hospital in the 1990s. Arch Intern Med 1996, 156:2454-2458.