Endocarditis: Who Is Particularly at Risk and Why? Ten Years Analysis of Risk Factors for In-hospital Mortality in Infective Endocarditis.

Background: Endocarditis is continuously increasing. Evidence exist that the prognosis is adversely affected by the extent of the disease. We looked at risk factors influencing in-hospital mortality (HM).
Patients and Methods: Between 2010 and 2019, 484 patients, 338 males (69.8%) with mean age of 66.1 years were operated on because of proven endocarditis. In a retrospective study, a risk factor analysis was performed.
Results: Overall HM was 30.17%. Significant influencing factors (odds ratios [ORs] or p -value) for HM were: age ( p  = 0.004), logistic EuroSCORE ( p < 0.001), gender (OR = 1.64), dialysis (OR = 2.64), hepatic insufficiency (OR = 2.17), reoperation (OR = 1.77), previously implanted valve (OR = 1.97), periannular abscess (OR = 9.26), sepsis on admission (OR = 12.88), and number of involved valves (OR = 1.96). Development of a sepsis and HM was significantly lower if Streptococcus mitis was the main pathogen in contrast to other bacteria ( p < 0.001). Staphylococcus aureus was significantly more often found in patients with a previously implanted prosthesis ( p  = 0.03) and in recurrent endocarditis ( p  = 0.02), while it significantly more often showed peripheral septic emboli than the other pathogens ( p < 0.001).
Conclusion: Endocarditis remains life-threatening. Severe comorbidities adversely affected early outcome, particularly, in presence of periannular abscesses. Patients with suspected endocarditis should be admitted to a specialized heart center as early as possible. Streptococcus mitis appears to be less virulent than S. aureus . Further studies are required to verify these findings.
Competing Interests: None declared.
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