Risk Factors Associated with Poor Outcome in Patients with Infective Endocarditis: An Italian Single-Center Experience

Abstract

Background: Nowadays, infective endocarditis (IE) is still burdened by a high mortality. In the absence of an adequate prognostic stratification system, it is important to assess new predictors of poor outcomes. The aim of our study is to evaluate which factors were associated with higher mortality in IE patients. Methods: A retrospective cohort study enrolled patients with an IE diagnosis at the Infectious Diseases Clinic of the University ‘G. D’Annunzio’, Chieti, Italy from January 2013 to December 2019. For each patient, demographic, anamnestic and clinical information, embolic phenomena, laboratory and microbiologic data, treatment, and outcomes were collected and analyzed. A correlation analysis was performed. Results: Sixty-eight patients with EI were studied; among them, the mortality was 17.6%, 20.6%, and 23.5%, intra-hospital, at 1 month from discharge and at 6 months from discharge, respectively. Mortality was significantly correlated with age, estimated glomerular filtration rate, and procalcitonin values when considering either basal values (r = 0.266, p = 0.029), or values at 48–72 h from the start of an antibiotic therapy (r = 0.222; p < 0.05), cerebral embolization for 6-month mortality (r = 0.284; p = 0.019), and inadequate antibiotic therapy (r = 0.232, p < 0.05). Conclusions: Procalcitonin values, at EI diagnosis and at 48–72 h after starting antibiotics, are prognostic factors useful for stratifying patient risk, and for setting up a personalized treatment. Of note, cerebral embolization and an inappropriate empirical treatment were associated with a higher mortality in the short- and long-term.

Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses

“…Table 1 presents the results obtained from strategy 1 (imaging examinations) over the entire literature search period and includes 27 articles [ 7 , 11 , 20 , 21 , 25 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Table 2 presents the results obtained from strategy 2 (pathology and histopathology), also for the whole period [ 52 , 53 ].…”

“…The imaging tests predominantly used to detect embolisms were USG [ 11 ], CT [ 7 , 11 , 21 , 25 , 30 , 31 , 32 , 33 , 34 , 41 , 43 , 45 , 46 , 50 ], MRI [ 43 , 51 ], 18 F-FDG PET/CT [ 20 , 29 , 35 , 38 , 39 , 40 , 42 , 44 , 47 , 48 , 49 , 50 , 51 ], SPECT/CT [ 29 , 36 ], and CEUS [ 37 ]. More recent studies tended to use PET-CT, although many still used conventional CT as it is more readily available.…”

Endocarditis in the intensive care unit: an update

“…Finally, the indications for transcatheter procedures extend to include the elderly and frail and these patients are at greater risk of complications with increased mortality rates than prior cohorts. Increasing age, which is a trend also observed in patients admitted to the ICU for IE, seems associated with mortality as well [16,17,19,21]. Additional factors which have been associated with complications of IE, are congenital heart disease, congestive heart failure, a heavy burden of comorbidities and specific causative pathogens, that is S. aureus and fungi [3 & ].…”

“…Increased D-dimer levels were also associated with in-hospital mortality and 6-month mortality in an observational study of 613 non-ICU patients [23]. In a single center retrospective study in non-ICU patients, elevated serum procalcitonin concentrations both at admission and at 48–72 h were associated with in-hospital mortality [16]. Conversely, cardiac surgery is often reported as a protective factor regarding mortality [4 ▪ ,18,19].…”

“…In patients with IE, acute respiratory failure [4 ▪ ], acute kidney injury [3 ▪ ,4 ▪ ,15,16], sepsis [3 ▪ ,17,18], acute heart failure [3 ▪ ,4 ▪ ,18], acute neurological failure [3 ▪ ,16,19], multiorgan failure (as illustrated by high sequential organ failure assessment [SOFA] scores) [19–21], preexisting comorbidities [4 ▪ ,15] and disseminated intravascular coagulopathy are all common causes of ICU admission. All of these are also associated with high rates of mortality [3 ▪ ].…”