Clinical predictors of complications in patients with left–sided infective endocarditis: A retrospective study of 206 episodes

PURPOSE: Early identification of specific patient subgroups at high risk of developing life-threatening infective endocarditis (IE) complications is of paramount importance. Better stratification may allow more intensive treatment of these patients and positively influences clinical outcomes. METHODS: We carried out a retrospective survey of consecutive left-sided IE adult patients, admitted over a 15-year period to two main tertiary care centres in the Czech Republic. RESULTS: Among a group of 196 patients (155 males; median age 64 years), a total of 206 left-sided IE episodes were identified. Perivalvular extension of infection was most frequently seen in prosthetic aortic valve endocarditis (OR 6.706, p<0.0001). Valve prolapse/perforation during IE episodes was significantly associated with mitral valve IE (OR 2.136, p=0.026) and vegetation length (OR 1.055, p=0.009). Septic shock was significantly related to two main risk factors: S. aureus infection (OR 8.459, p=<0.0001) and smoking (OR 8.403, p=0.001). Mitral valve IE with a vegetation length ≥13 mm was the strongest risk factor for this complication (OR 3.24, p=0.001), followed by S. aureus infection (OR 3.59, p=0.002). Finally, septic shock (OR 6.000, p=0.001) represented the most important risk factor of in-hospital mortality. CONCLUSIONS: This study provides the most detailed profile of complication predictors related to left-sided IE in Central Europe. Early individual stratification of IE related occurrence of complications might help to decrease extremely high morbidity and mortality of this disease (Tab. 5, Ref. 37).