Key result
Among patients with infective endocarditis, cardiogenic shock was associated with 52.5% in-hospital mortality, which was lower than the 62.3% mortality observed in those with septic shock (P=0.008).
Why the study?
Studies investigating the impact of cardiogenic shock on endocarditis are lacking.
Cohort (n=4,856)
Yes
Absolute Event Rate: 52.5% vs 62.3%
p-value: p=0.008
Cardiogenic shock complicates 5% of infective endocarditis cases and carries a high mortality rate, highlighting the critical need for prompt identification and surgical intervention.
CS in endocarditis signals need for surgical readiness; leaves open optimal timing and survival impact.
BACKGROUND: Studies investigating the impact of cardiogenic shock (CS) on endocarditis are lacking. METHODS: Prospectively collected cohort from 35 Spanish centers (2008-2018). Logistic regression analyses were performed to identify risk factors for developing CS and predictors of mortality. RESULTS: Among 4856 endocarditis patients, 1652 (34%) had acute heart failure (AHF) and 244 (5%) CS. Compared with patients without AHF and AHF but no CS, patients with CS presented higher rates of surgery (40.5%, 52.5%, and 68%; P < .001) and in-hospital mortality (16.3%, 39.1%, and 52.5%). Compared with patients with septic shock, CS patients presented higher rates of surgery (42.5% vs 68%; P < .001) and lower rates of in-hospital and 1-year mortality (62.3% vs 52.5%, P = .008, and 65.3% vs 57.4%, P = .030). Severe aortic and mitral regurgitation (OR [95% CI], 2.47 [1.82-3.35] and 3.03 [2.26-4.07]; both P < .001), left-ventricle ejection fraction <60% (1.72; 1.22-2.40; P = .002), heart block (2.22; 1.41-3.47; P = .001), tachyarrhythmias (5.07; 3.13-8.19; P < .001), and acute kidney failure (2.29; 1.73-3.03; P < .001) were associated with higher likelihood of developing CS. Prosthetic endocarditis (2.03; 1.06 -3.88; P = .032), Staphylococcus aureus (3.10; 1.16 -8.30; P = .024), tachyarrhythmias (3.09; 1.50-10.13; P = .005), and not performing cardiac surgery (11.40; 4.83-26.90; P < .001) were associated with a higher risk of mortality. CONCLUSIONS: AHF is common among patients with endocarditis. CS is associated with high mortality and should be promptly identified and assessed for cardiac surgery.
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Pericàs et al. (2021) conducted a cohort in Infective Endocarditis (n=4,856). Cardiogenic shock vs. Septic shock was evaluated on In-hospital mortality (p=0.008). Among patients with infective endocarditis, cardiogenic shock was associated with 52.5% in-hospital mortality, which was lower than the 62.3% mortality observed in those with septic shock (P=0.008).
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