Key result
Major complications linked to ~4.2-fold higher mortality in infective endocarditis.
Why the study?
Despite advancements in diagnostic imaging and antimicrobial protocols, infective endocarditis incidence and disease burden continue to rise globally, necessitating evaluation of contemporary diagnostic and treatment approaches and mortality predictors.
Cohort (n=470)
Yes
Hazard Ratio: 4.207 (95% CI 1.556–11.378)
p-value: p=0.005
Contemporary infective endocarditis continues to carry a high overall mortality (26.4%), with hospital-acquired infection and major clinical complications acting as the strongest independent predictors of death.
Major complications and hospital acquisition predict higher mortality in infective endocarditis; leaves open whether targeted prevention improves outcomes.
Background: Despite continuous advancements in diagnostic imaging and targeted antimicrobial protocols for infective endocarditis (IE), global epidemiological data show that both disease burden and incidence continue to rise. This study aimed to evaluate real-world diagnostic and treatment approaches in accordance with the 2023 European Society of Cardiology (ESC) IE Guidelines and to identify independent predictors of mortality in a contemporary patient cohort. Methods: This multicenter, retrospective cohort study analyzed data from 470 consecutive adult patients diagnosed with IE across 27 academic reference centers between 1 September 2023 and 1 June 2025. Patients were managed and adjudicated according to the 2023 ESC diagnostic criteria. Demographic data, clinical characteristics, microbiological profiles, imaging findings, empirical antibiotic therapy patterns, and clinical outcomes were analyzed. Independent predictors of mortality were determined using multivariable Cox proportional hazards regression models. Results: The mean age of the overall study population was 58.08 ± 16.81 years, with a male predominance (60.6%, n = 285). Staphylococcus aureus was the most frequently isolated pathogen (27.9%), with a high proportion of methicillin resistance (38.9%). Hospital-acquired IE was identified in 41.1% of cases. Surgical treatment was performed in 40.6% (n = 191) of the cohort. The 28-day mortality rate was 11.9%, and the overall mortality during follow-up reached 26.4%. Multivariable Cox regression analysis identified hospital-acquired IE (HR = 2.247; 95% CI: 1.216–4.167; p = 0.010) and the presence of major clinical complications (HR = 4.207; 95% CI: 1.556–11.378; p = 0.005) as the strongest independent predictors of mortality. Conclusions: Contemporary infective endocarditis is a highly complex and fatal disease characterized by a prominent healthcare-associated burden and a predominant staphylococcal etiology. The occurrence of major clinical complications and hospital-acquired infections were the primary independent predictors of mortality.
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Kış et al. (2026) conducted a cohort in Infective endocarditis (n=470). Major clinical complications vs. Absence of major clinical complications was evaluated on Mortality (HR 4.207, 95% CI 1.556-11.378, p=0.005). Major clinical complications (HR 4.207; 95% CI 1.556-11.378) and hospital-acquired infection (HR 2.247) were the strongest independent predictors of mortality in infective endocarditis.
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