Endocarditis at a tertiary hospital: reduced acute mortality but poor long term prognosis.
The outcome in 132 patients with infective endocarditis diagnosed in accordance with the Duke criteria at a tertiary hospital in Denmark in the period 1998-2000 is reported. The total in-hospital mortality was 15%. Indications are that in-hospital mortality over the last decade has been reduced by around a quarter. Mortality after 3 months was 17% (CI 29%), after 3 years 32% (CI 16-47%) and after 5 years 39% (CI 22-55%). This 5-years mortality was 5 times that of an age and gender matched background population. After follow-up for 5-8 y, mortality was highest for prosthetic valve endocarditis (63% vs. 39%, p = 0.05). Heart surgery was performed in 51% of the cases. Patients who underwent surgery had a lower mortality at follow-up (36% vs. 52%, p = 0.04). The 5-year mortality was 30% (CI 9-52%) for patients treated with surgery and 48% (CI 23-72%) for patients treated without surgery. In multivariable analysis surgery was not an independent predictor for lower long-term mortality. Surgery was however an independent predictor for lower intermediate-term mortality. It is concluded that surgery may be associated with lower short- and intermediate-term mortality, while the effect might decline in the long-term. High age, prosthetic valve endocarditis, and Staphylococcus aureus endocarditis were independent predictors for high mortality. Although improvements have occurred over recent years, infective endocarditis is still a high mortality disease.
Tran
Cao Thach
CT
Laboratory for Molecular Cardiology, Medical Department B, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark. tran@tele2adsl.dk
Kjeldsen
Keld
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013211:Staphylococcus aureus / Q000254:growth & development; D015996:Survival Rate