SPC365

Endocarditis in-hospital mortality: what can we expect?

Session: Posters (Sessão 5 - Écran 8) - Doença Valvular 4 - Foco na Endocardite
Speaker: Catarina Oliveira

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Catarina Simões de Oliveira; Sara Couto Pereira; Pedro Silvério António; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Ana Beatriz Garcia; Ana Margarida Martins; Miguel Azaredo Raposo; Catarina Gregório; João Santos Fonseca; Ana Abrantes; Pedro Carrilho Ferreira; Fausto j. Pinto

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Infective endocarditis (IE) is a deadly disease. Despite diagnostic and therapeutic advances, it remains a challenging illness, with high mortality and serious complications. Early identification of high-risk patients could promote the best therapeutic strategy and improve outcomes.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To evaluate predictors of in-hospital mortality in patients with IE.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Single centre observational study of 219 patients with IE established by Duke modified criteria and 2015 ESC modified criteria, admitted to a tertiary hospital between 2010 and 2020. Clinical and demographic characteristics, laboratorial and microbiological results and echocardiographic features at baseline were analyzed. Chi-square and Mann-Whitney tests, Cox-regression for multivariate analysis and Kaplan-Meier to assess survival were used.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In-hospital death occurred in 25% of pts (n=54). Mean age was 69,3&plusmn;15,7-years and 63% were man. Arterial hypertension (57%), diabetes (24,1%), cancer (13%) and immunosuppression (13%) were the main co-morbidities. 37% had an acquired valvular disease (33,3% with prosthetic valve). Most common etiologic agents were S. aureus (24%) and Enterococcus spp (24%).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding in-hospital complications 24,1% of pts needed mechanical ventilation and renal replacement therapy and 29,6% evolved to sepsis. Considering local complications, 16,7% had valvular abscess, 5,5% prothesis disfunction and 5,5% cardiac fistula, with a positive correlation of abscess and cardiac fistula with in-hospital mortality (p=0,027 and p=0,002, respectively).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">On univariate analysis, we observed a positive correlation of in-hospital mortality with presence of prosthetic valve (p=0,010), NTproBNP &gt;2000pg/mL (p&lt;0,001) as well as evidence of vegetations in the first echocardiographic evaluation (p=0.026) and immunosuppression (p=0.004).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">At diagnosis or during hospitalization, 22,2% of pts had cerebral embolization, which also correlated with mortality (p=0.011).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">On multivariate analysis, immunosuppression (CI 95% 1,261 &ndash; 8,687) cardiac fistula (CI 95% 1,074 &ndash; 20,796) and cardiogenic shock (CI 95% 1,154 &ndash; 5,190) were independent predictors of mortality.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> In our cohort, mortality was as high as 25% and NTproBNP and vegetation at echo were associated with an unfavorable outcome. Immunosuppression, cardiac fistula and cardiogenic shock were independent predictors of death.</span></span></span></p>

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