ABSTRACT
OBJECTIVE: To evaluate predictors of long term prognosis in infective endocarditis. DESIGN: Retrospective cohort study. SETTING: Tertiary care centre. PATIENTS: 212 consecutive patients with infective endocarditis between 1980 and 1995 MAIN OUTCOME MEASURES: Overall and cardiac mortality; event-free survival; and the following events: recurrence, need for late valve surgery, bleeding and embolic complications, cerebral dysfunction, congestive heart failure. RESULTS: During a mean follow up period of 89 months (range 1-244 months), 56% of patients died. In 180 hospital survivors, overall and cardiac mortality amounted to 45% and 24%, respectively. By multivariate analysis, early surgical treatment, infection by streptococci, age < 55 years, absence of congestive heart failure, and > 6 symptoms or signs of endocarditis during active infection were predictive of improved overall long term survival. Independent determinants of event-free survival were infection by streptococci and age < 55 years. Event-free survival was 17% at the end of follow up both in medically-surgically treated patients and in medically treated patients. CONCLUSIONS: Long term survival following infective endocarditis is 50% after 10 years and is predicted by early surgical treatment, age < 55 years, lack of congestive heart failure, and the initial presence of more symptoms of endocarditis.
Subject(s)
Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Brain Diseases/etiology , Brain Diseases/mortality , Cohort Studies , Disease-Free Survival , Embolism/etiology , Embolism/mortality , Europe/epidemiology , Female , Heart Failure/etiology , Heart Valve Diseases/etiology , Heart Valve Diseases/surgery , Hospital Mortality , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Risk Factors , Staphylococcal Infections/complications , Streptococcal Infections/complications , Survival Analysis , Time FactorsABSTRACT
OBJECTIVE: To evaluate recent changes in the spectrum and clinical presentation of infective endocarditis and to determine predictors of outcome. DESIGN: A retrospective case study. METHODS: Demographic, clinical, and echocardiographic characteristics were examined in 212 patients who fulfilled the Duke criteria for infective endocarditis between January 1980 and December 1995 to assess changes in clinical presentation and survival. RESULTS: Clinical presentation and course did not change significantly during the study period despite the concurrent introduction of new diagnostic tools (for example, transoesophageal echocardiography). In-hospital mortality was 15% and remained unchanged. Neurological symptoms on admission, arthralgia, and weight loss were all independent risk factors for adverse outcome (odds ratios 26.1, 6.2, and 4.2, respectively). Age, prosthetic valve disease, previous antibiotic treatment, renal insufficiency, surgical treatment, and the type of valve involved were not predictive of mortality. In contrast to all other major reports, Streptococcus viridans was the most common causative organism in intravenous drug users (52%). CONCLUSIONS: Despite the introduction of new diagnostic tools, the course of infective endocarditis has remained unchanged over a period of 16 years. Evidence of early dissemination of the disease to other sites was associated with adverse outcome. Even in elderly patients, early aggressive treatment seems to be effective.
