[Trend and contributing factors of in-hospital deaths in patients with infective endocarditis over the last twenty years].
OBJECTIVE
To evaluate the changes in the clinical background to infective endocarditis and identify the contributing factors to in-hospital deaths over the last 20 years.


METHODS
Seventy-five patients (mean age 48.2 +/- 24.0 years) with infective endocarditis treated between January 1984 and December 2003 at our hospital were evaluated retrospectively. The patients were divided into two groups (first decade, n = 26 and second decade, n = 49).


RESULTS
The infection route was unknown in 65% of the patients, but the oral route was the most common known route (16.0%). Congenital heart disease (24.0%)was the most common background disease, followed by valvular heart disease (22.7%), and post prosthetic valve replacement (22.7%). The mitral valve was most frequently infected(56.0%), followed by the aortic valve (34.7%). Multi-valve infection was present in 13.3% of the patients. Although the frequency of streptococcal endocarditis reduced, that of staphylococcal endocarditis increased in the second decade. The overall in-hospital mortality was 26.7%, but slightly improved in the second decade (34.6% vs 22.4%, p = 0.26). The overall in-hospital mortality was similar between the surgically treated group and the non-surgically treated group (25.0% vs 27.3%, NS). In the surgically treated group, in-hospital mortality was lower in the second decade than the first decade, but higher in the group treated for active infective endocarditis. Multivariate analysis found age > or = 51 years, renal insufficiency, neurological abnormality, and culture negative as predictors of in-hospital mortality.


CONCLUSIONS
Rapid and appropriate primary medical treatment are important in the active phase of infective endocarditis. Age > or = 51 years was the strongest predictor of in-hospital infective endocarditis death.
Ejima
Koichiro
K
Department of Cardiology, Tokyo Women's Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo 162-8666. koichiro@qf6.so-net.ne.jp
Oka
Toshiaki
T
Tanimoto
Kyomi
K
Ishizuka
Naoko
N
Kasanuki
Hiroshi
H
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006349:Heart Valve Diseases / Q000150:complications; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology; D013290:Streptococcal Infections / Q000453:epidemiology