title: Complicated infective endocarditis necessitating ICU admission: clinical course and prognosis.
abstract: OBJECTIVE
  To study incidence, clinical course and prognostic factors in patients admitted to medical intensive care units (ICUs) because of a complicated course of infective endocarditis.
  
  
  METHODS
  This was a retrospective multicenter observational study of 4106 patients admitted to four medical ICUs in one tertiary hospital and one university hospital between 1994 and 1999.
  
  
  RESULTS
  Infective endocarditis was identified in 33 (0.8%) patients. Of these, 26 were male, mean age was 59 +/- 12 and APACHE-III score was 75 +/- 31. Reasons for transfer to the ICU were congestive heart failure in 64%, septic shock in 21%, neurological deterioration in 15% and cardiopulmonary resuscitation in 9%. Inotropes or vasoconstrictors were required in 73% and multiorgan failure developed in 64% of the patients. Prosthetic valve endocarditis was present in 21%. Gram-positive cocci were found in 96% of all positive cultures; cultures were negative in 27% of the patients. Transthoracic echocardiograms were diagnostic in only 33% and transesophageal studies were required in 91% to confirm diagnosis or fully to delineate the extent of disease. Surgical intervention was performed in 60% of the patients, and the remaining 40% were only treated medically. The APACHE-III score on admission did not differ statistically between the two groups (69 +/- 30 versus 84 +/- 34, P = 0.17). In-patient mortality was 84% in patients treated medically, and 35% in surgically treated patients. Using multivariate analysis, acute renal failure on admission was identified as the independent single predictor for in-patient death (OR 5, 95% CI 1.04-24.03, P = 0.04).
  
  
  CONCLUSIONS
  The prognosis for patients with infective endocarditis requiring admission to a medical ICU is serious. Nevertheless, the data suggest that surgical intervention may be successfully performed in a substantial number of patients despite the presence of severe shock and occurrence of multiorgan failure.
authors: Resident, Department of Cardiology, University of Vienna, Austria. georg.delle-karth@univie.ac.at
authors: Georg
authors: G
authors: Karth
authors: Maria
authors: M
authors: Koreny
authors: Thomas
authors: T
authors: Binder
authors: Sylvia
authors: S
authors: Knapp
authors: Christian
authors: C
authors: Zauner
authors: Andreas
authors: A
authors: Valentin
authors: Rosemarie
authors: R
authors: Honninger
authors: Gottfried
authors: G
authors: Heinz
authors: Peter
authors: P
authors: Siostrzonek
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003422:Critical Care; D016638:Critical Illness; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents