SPC365

Landscape of Infective Endocarditis in a Portuguese tertiary center: Demographic Trends, Risk Profiles and Clinical Variability

Session: Sessão de Posters 44 - Endocardite Infecciosa
Speaker: João Fernandes Pedro

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.8 Infective Endocarditis - Other
Session Type: Cartazes
FP Number: ---
Authors: João Fernandes Pedro; Ana Margarida Martins; Catarina Oliveira; Ana Beatriz Garcia; Catarina Gregório; Miguel Azaredo Raposo; João Fonseca; Ana Abrantes; João Cravo; Pedro Carrilho Ferreira; Catarina de Sousa; Fausto J. Pinto

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#212121"><span style="background-color:#ffffff">Despite its lower incidence, infective endocarditis (IE) requires careful consideration due to a complex clinical presentation, frequent need for surgical intervention and extended hospital stay as well as significant in-hospital mortality rate. Identifying predictors of a poorer prognosis is crucial for directing appropriate medical care and anticipating adverse clinical outcomes. Additionally, the dynamic epidemiology of IE, along with an observed increase in incidence in recent years, underscores the need for a contemporary review.&nbsp;</span></span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><strong>Aim</strong></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#212121"><span style="background-color:#ffffff">The scope of this paper was to characterize a population admitted with IE in a tertiary center during a 13-year period, to evaluate clinical outcomes and to identify predictors of in-hospital mortality.</span></span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#212121"><span style="background-color:#ffffff"><strong>Methods</strong></span></span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#212121"><span style="background-color:#ffffff">We conducted a retrospective, observational study including patients with the diagnosis of IE (according to Duke criteria) admitted in tertiary center between 2010 and 2022. Data on comorbidities, clinical presentation, microbiology and clinical outcomes during hospitalization were collected. Risk factors of in-hospital death were analyzed. Cox regression was used to define predictors.</span></span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#000000">We included a total of 177 patients (64,4% male, 67&plusmn;14 years). 18,1% of the patients had prosthetic valves and the aortic valve was the most affected. <em>Staphyloccocus aureus</em> and <em>Streptoccocus bovis</em> were </span><span style="color:#212121"><span style="background-color:#ffffff">the most commonly isolated microorganisms. 53 pts (30%) underwent cardiac surgery. To evaluate the temporal trends of the epidemiology of endocarditis we analyzed patients with IE diagnosis from January 2010 to June 2016 (85pts) and from July 2016 to December 2022 (92pts). There was a notable change in the IE related microorganisms, with a higher prevalence of&nbsp; S. <em>aureus</em> between 2016 and 2022 (p=0.007). This is probably explained by a significant increase in pts with central lines and cardiac devices (p=0.02 and p=0.04). There was no change regarding the in-hospital mortality rate or surgical rate.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#212121"><span style="background-color:#ffffff">Observed in-hospital mortality rate was 22%. The identified risk-factors for in-hospital mortality were the presence of signs and/ symptoms of heart failure at admission (OR=2.61 95% CI1.34 -4.91, p=0.003), sepsis (OR=1.95 95%CI 1.02 &ndash; 3.73, p=0.04) and left ventricular ejection fraction (LVEF) (OR=0.97 95% CI 0.95-0.99, p=0.004).</span></span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#212121"><span style="background-color:#ffffff"><strong>Conclusion</strong></span></span></span></span></p>

<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:#212121"><span style="background-color:#ffffff">IE is still associated with a dismal prognosis with a significant rate of cardiac surgery and high in-hospital mortality rates. A mild increase in IE cases and notably a rise in S. <em>aureus</em> involvement, most likely explained by in hospital colonization and higher presence of central lines and implantable cardiac devices, was noted in our center in the last decade. Such findings translate into an increased complexity of IE cases, with significant challenges to clinical teams dealing with this pathology.</span></span></span></span></p>