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Open Access Highly Accessed Research article

Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort

Juan Gálvez-Acebal1*, Jesús Rodríguez-Baño1, Francisco J Martínez-Marcos2, Jose M Reguera3, Antonio Plata3, Josefa Ruiz4, Manuel Marquez4, Jose M Lomas2, Javier de la Torre-Lima5, Carmen Hidalgo-Tenorio6, Arístides de Alarcón7 and the Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)

Author Affiliations

1 Infectious Diseases Section, University Hospital Virgen Macarena, Sevilla. Spain

2 Infectious Diseases Unit, General Hospital Juan Ramón Jiménez, Huelva. Spain

3 Infectious Diseases Service, University Hospital Carlos Haya, Málaga. Spain

4 Infectious Diseases Section, University Hospital Virgen de la Victoria, Málaga. Spain

5 Internal Medicine Service, Hospital Costa del Sol, Marbella. Spain

6 Infectious Diseases Section, University Hospital Virgen de las Nieves, Granada. Spain

7 Infectious Diseases Service, University Hospital Virgen del Rocío, Sevilla. Spain

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BMC Infectious Diseases 2010, 10:17  doi:10.1186/1471-2334-10-17

Published: 22 January 2010

Abstract

Background

Despite medical advances, mortality in infective endocarditis (IE) is still very high. Previous studies on prognosis in IE have observed conflicting results. The aim of this study was to identify predictors of in-hospital mortality in a large multicenter cohort of left-sided IE.

Methods

An observational multicenter study was conducted from January 1984 to December 2006 in seven hospitals in Andalusia, Spain. Seven hundred and five left-side IE patients were included. The main outcome measure was in-hospital mortality. Several prognostic factors were analysed by univariate tests and then by multilogistic regression model.

Results

The overall mortality was 29.5% (25.5% from 1984 to 1995 and 31.9% from 1996 to 2006; Odds Ratio 1.25; 95% Confidence Interval: 0.97-1.60; p = 0.07). In univariate analysis, age, comorbidity, especially chronic liver disease, prosthetic valve, virulent microorganism such as Staphylococcus aureus, Streptococcus agalactiae and fungi, and complications (septic shock, severe heart failure, renal insufficiency, neurologic manifestations and perivalvular extension) were related with higher mortality. Independent factors for mortality in multivariate analysis were: Charlson comorbidity score (OR: 1.2; 95% CI: 1.1-1.3), prosthetic endocarditis (OR: 1.9; CI: 1.2-3.1), Staphylococcus aureus aetiology (OR: 2.1; CI: 1.3-3.5), severe heart failure (OR: 5.4; CI: 3.3-8.8), neurologic manifestations (OR: 1.9; CI: 1.2-2.9), septic shock (OR: 4.2; CI: 2.3-7.7), perivalvular extension (OR: 2.4; CI: 1.3-4.5) and acute renal failure (OR: 1.69; CI: 1.0-2.6). Conversely, Streptococcus viridans group etiology (OR: 0.4; CI: 0.2-0.7) and surgical treatment (OR: 0.5; CI: 0.3-0.8) were protective factors.

Conclusions

Several characteristics of left-sided endocarditis enable selection of a patient group at higher risk of mortality. This group may benefit from more specialised attention in referral centers and should help to identify those patients who might benefit from more aggressive diagnostic and/or therapeutic procedures.