title: Clinical and prognostic profile of patients with infective endocarditis who need urgent surgery.
abstract: OBJECTIVE
  Surgery in patients with infective endocarditis (IE) can be elective (upon completion of antibiotic treatment) or urgent (before antibiotic treatment has ended) when the clinical course is unfavourable. However, urgent surgery for left-sided endocarditis is associated with high mortality. The aims of this study were to describe the profile of patients with left-sided endocarditis who underwent urgent surgery and to analyse the factors that predicted mortality.
  
  
  RESULTS
  Among 508 consecutive episodes of IE, 391 were left-sided and 89 required urgent surgery. The main reasons for urgent surgery were heart failure that did not respond to medication (72%) and persistent infection despite appropriate antibiotic treatment (31%). Thirty-two patients (36%) died during their hospital stay. Univariate analysis identified renal failure, septic shock, Gram-negative bacteria, persistent infection, and surgery for persistent infection as factors associated with mortality. Multivariate analysis confirmed only persistent infection and renal insufficiency as factors independently associated with a poor prognosis.
  
  
  CONCLUSIONS
  Patients with IE who need urgent surgery have a poor clinical course. Heart failure, the main cause of urgent surgery, was not associated with higher mortality. However, persistent infection and renal failure were factors associated with higher post-surgical mortality.
authors.affiliation: Department of Cardiology and Cardiac Surgery, Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Ramón y Cajal 3-5, 47005 Valladolid, Spain. arevillaorodea@gmail.com
authors.forename: Ana
authors.initials: A
authors.lastname: Revilla
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villacorta
authors.forename: María J
authors.initials: MJ
authors.lastname: Rollán
authors.forename: José R
authors.initials: JR
authors.lastname: Echevarría
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Carrascal
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Stefano
authors.forename: Enrique
authors.initials: E
authors.lastname: Fulquet
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez
authors.forename: Luis
authors.initials: L
authors.lastname: Fiz
authors.forename: José A
authors.initials: JA
authors.lastname: San Román
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004638:Emergency Treatment; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents