title: Relapses, recurrences, valve replacements, and mortality during the long-term follow-up after infective endocarditis.
abstract: BACKGROUND
  Late prognosis after infective endocarditis has not been systematically studied in large series of patients with different underlying heart conditions in recent years.
  
  
  METHODS
  We studied an inception cohort study of 420 patients discharged after treatment of endocarditis from a university tertiary care hospital. The patients were aged 34.2+/-17.2 years (mean +/- SD), ranging from 2 months to 83 years; 270 (64.3%) were men and 150 (35.7%) were women. Mean follow-up was 6.1+/-4.3 years for survivors and 3.7+/-3.7 years for the patients who died during the follow-up. We studied the frequency and risk factors for relapses and recurrences of endocarditis, cardiac valve replacements, and deaths during the follow-up. Statistical analysis was performed through comparison of groups, of event-free survival, and risk ratios.
  
  
  RESULTS
  Relapses were observed in 14 (3.3%) patients. There was one recurrence of endocarditis in 48 (11.4%) patients, two (0.5%) in 2 patients, three in 1 patient (0.2%), and five (0.2%) in 1 patient. Valve replacement was performed in 83 (19.7%) patients. Ninety-eight (12.3%) patients died. Risk factors for recurrent endocarditis were increasing age (risk ratio 1.02) and male sex (risk ratio 1.61). Risk factors for valve replacement were recurrent endocarditis (risk ratio 1.62) and prosthetic valve endocarditis (risk ratio 1.61). Risk factors for death were increasing age (risk ratio 1.03) and recurrent endocarditis (risk ratio 2.06).
  
  
  CONCLUSIONS
  The long-term event-free survival for patients who survived their first episode of endocarditis was low. Recurrent endocarditis, prosthetic valve endocarditis, and increasing age contributed to the high rate of events during the follow-up.
authors.affiliation: Heart Institute-InCor, São Paulo University Medical School, São Paulo, Brazil. ajmansur@incor.usp.br
authors.forename: A J
authors.initials: AJ
authors.lastname: Mansur
authors.forename: C M
authors.initials: CM
authors.lastname: Dal Bó
authors.forename: J T
authors.initials: JT
authors.lastname: Fukushima
authors.forename: V S
authors.initials: VS
authors.lastname: Issa
authors.forename: M
authors.initials: M
authors.lastname: Grinberg
authors.forename: P M
authors.initials: PM
authors.lastname: Pomerantzeff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004696:Endocarditis / Q000382:microbiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors