Key result
Surgical treatment for infective endocarditis was associated with lower in-hospital mortality compared to conservative clinical management (34.1% vs 49.4%; OR 0.45; 95% CI 0.2-0.9; p=0.047).
Why the study?
Infective endocarditis remains a major health problem with high morbidity and mortality, yet epidemiological and microbiological data remain scarce, particularly in developing countries.
Does surgical treatment reduce in-hospital mortality in patients with infective endocarditis compared to clinical treatment?
Observational (n=167)
No
Does surgical treatment reduce in-hospital mortality in patients with infective endocarditis compared to clinical treatment?
Odds Ratio: 0.45 (95% CI 0.2–0.9)
Absolute Event Rate: 34.1% vs 49.4%
p-value: p=0.047
In patients with infective endocarditis, surgical treatment was associated with significantly lower in-hospital mortality compared to conservative clinical management.
Background: Infective endocarditis (IE) remains an expressive health problem with high morbimortali-ty rates. Despite its importance, epidemiological and microbiological data remain scarce, especially in developing countries. Aim: This study aims to describe IE epidemiological, clinical, and microbiological profile in a tertiary university center in South America, and to identify in-hospital mortality rate and predictors. Methods: Observational, retrospective study of 167 patients, who fulfilled modified Duke’s criteria during a six-year enrollment period, from January 2010 to December 2015. Primary outcome was de-fined as in-hospital mortality analyzed according to treatment received (clinical vs. surgical). Multivari-ate analysis identified mortality predictors. Results: Median age was 60years (Q1-Q3 50-71), and 66% were male. Echocardiogram demonstrated vegetations in 90.4%. An infective agent was identified in 76.6%, being Staphylococcus aureus (19%), Enterococcus (12%), Coagulase-negative staphylococci (10%), and Streptococcus viridans (9.6%) the most prevalent. Overall in-hospital mortality was 41.9%, varying from 49.4% to 34.1%, in clinical and surgical patients, respectively (p=0.047). On multivariate analysis, diabetes mellitus (OR 2.5), previous structural heart disease (OR 3.1), and mitral valve infection (OR 2.1) were all-cause death predictors. Surgical treatment was the only variable related to better outcome (OR 0.45; 95%IC 0.2-0.9). Conclusion: This study presents IE profile and all-cause mortality in a large patient’s cohort, compris-ing a 6-years’ time window, a rare initiative in developing countries. Elderly and male patients predom-inated, while Staphylococcus aureus was the main microbiological agent. Patients conservatively treated presented higher mortality than surgically managed ones. Epidemiological studies from developing countries are essential to increase IE understanding.
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Tagliari et al. (2020) conducted an observational in Infective endocarditis (n=167). Surgical treatment vs. Clinical treatment was evaluated on In-hospital mortality (OR 0.45, 95% CI 0.2-0.9, p=0.047). Surgical treatment for infective endocarditis was associated with lower in-hospital mortality compared to conservative clinical management (34.1% vs 49.4%; OR 0.45; 95% CI 0.2-0.9; p=0.047).
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