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

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Abstract

Abstract

Background
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.

Pages

Methods
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.

Results
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.

Conclusion
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.

Background
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].

Pages

References
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