Infective endocarditis in the intensive care unit: clinical spectrum and prognostic factors in 228 consecutive patients.
OBJECTIVE
To identify factors associated with in-hospital outcome of adult patients admitted to the ICU with infective endocarditis (IE).


METHODS
Retrospective study performed in the two medical ICUs of a teaching hospital.


METHODS
The charts of all 228 consecutive patients aged 18 years or older admitted with infective IE between January 1993 and December 2000 were reviewed. All patients satisfied the modified Duke's criteria for definite IE.


RESULTS
There were 146 episodes of native valve endocarditis and 82 of prosthetic valve endocarditis. Staphylococcus aureus was the predominant causative micro-organism. Most complications occurred early during the course of IE. One-half of the patients underwent cardiac surgery during the same hospitalization and had a better outcome than nonoperated patients. The overall in-hospital mortality rate was 45% (102/228). Multivariate analysis revealed the following clinical factors in patients with native valve IE as independently associated with outcome: septic shock (odds ratio 4.81), cerebral emboli (3.00), immunocompromised state (2.88), and cardiac surgery (0.475); in patients with prosthetic valve IE the factors were: septic shock (4.07), neurological complications (3.1), and immunocompromised state (3.46).


CONCLUSIONS
IE still carries high morbidity and mortality rates for the subset of patients requiring ICU admission. Most complications occur early making the decision process for optimal medical and surgical management more difficult. Surgical treatment appears to improve in-hospital outcome.
Mourvillier
Bruno
B
Service de Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat-Claude-Bernard, AP-HP, 46 rue Henri-Huchard, 75877 Paris Cedex 18, France.
Trouillet
Jean-Louis
JL
Timsit
Jean-François
JF
Baudot
Jérome
J
Chastre
Jean
J
Régnier
Bernard
B
Gibert
Claude
C
Wolff
Michel
M
D006348:Cardiac Surgical Procedures / Q000401:mortality; D004696:Endocarditis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010297:Paris / Q000453:epidemiology; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome