[Predictors of hospital mortality in 186 cases of active infective endocarditis treated in a tertiary medical center (1992-2001)].
OBJECTIVE
The aim of this study was to describe the predictors of hospital mortality found in patients admitted for infective endocarditis (IE) to a cardiovascular surgery ward. Patients and method. Prospective study of 186 patients with IE treated in our hospital between 1992 and 2001.


RESULTS
One hundred fourteen patients (61.3%) had native valve endocarditis and 72 (38.7%) had prosthetic valve endocarditis (early in 28 patients [up to 12 months after surgery] and late in 44 [later than 12 months]). Blood cultures were positive in 82%. The predominant organism was Streptococcus viridans (36%) in native valve endocarditis and Staphylococcus aureus (33%) in prosthetic valve endocarditis. The hospital mortality was 22.6%. Severe sepsis (4.8%) produced a high mortality rate (88%) and was caused by Staphylococcus aureus in 60%. One hundred nineteen patients (64%) required surgery, 79 (66.4%) of them urgently. Negative blood cultures predicted need for surgery in native valve endocarditis (p < 0.05). The surgical mortality was 21.8% and was related to NYHA III-IV class (p = 0.014) and emergency surgery (p = 0.009) in patients with native valve endocarditis. This last factor also predicted higher surgical mortality in patients with early prosthetic valve endocarditis (p < 0.001).


CONCLUSIONS
The hospital mortality of this group of patients with infective endocarditis treated in a tertiary medical center was high. The presence of severe sepsis, although infrequent, had a somber prognosis. Severe heart failure in native valve endocarditis and urgent surgery in native and prosthetic valve endocarditis increased surgical mortality.
Horacio Casabé
J
J
Instituto de Cardiología y Cirugía Cardiovascular (ICYCC). Fundación Favaloro. Buenos Aires. Argentina.
Deschle
Héctor
H
Cortés
Claudia
C
Stutzbach
Pablo
P
Hershson
Alejandro
A
Nagel
Claudia
C
Guevara
Eduardo
E
Torino
Augusto
A
Raffaelli
Héctor
H
Favaloro
Roberto R
RR
Suárez
Luis D
LD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality* / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000382:microbiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality