Early predictors of in-hospital death in infective endocarditis.
BACKGROUND
Data on early determinants of outcome in infective endocarditis (IE) are limited. We evaluated the prognostic significance of early clinical characteristics in a large, prospective cohort of patients with IE.


RESULTS
Two hundred sixty-seven consecutive patients with definite or possible IE by modified Duke criteria and echocardiography performed within 7 days of presentation were evaluated. Acute physiology was assessed by the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score at the time of presentation, and early heart failure was diagnosed by Framingham criteria. In-hospital mortality rate in the cohort was 19% and similar for patients with definite or possible IE (20% versus 16%, respectively; P=0.464). Independent predictors of death determined by logistic regression modeling were diabetes mellitus (OR 2.48; 95% CI, 1.24 to 4.96), Staphylococcus aureus as causative organism (OR, 2.06; 95% CI, 1.01 to 4.20), APACHE II score (OR, 1.07; 95% CI, 1.01 to 1.12), and embolic event (OR, 2.79; 95% CI, 1.15 to 6.80). Early echocardiographic findings of the Duke criteria were not predictive of death.


CONCLUSIONS
Early in the course of IE, readily available clinical characteristics that reflect the host-pathogen interaction are predictive of in-hospital death. These factors may identify those patients with IE for more aggressive treatment.
Chu
Vivian H
VH
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Cabell
Christopher H
CH
Benjamin
Daniel K
DK
Kuniholm
Erin F
EF
Fowler
Vance G
VG
Engemann
John
J
Sexton
Daniel J
DJ
Corey
G Ralph
GR
Wang
Andrew
A
D018806:APACHE; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004617:Embolism / Q000209:etiology / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006351:Heart Valves / Q000000981:diagnostic imaging; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009657:North Carolina / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000401:mortality; D014463:Ultrasonography