Clinical and echocardiographic predictors of morbidity and mortality in infective endocarditis: the significance of vegetation size.
BACKGROUND
Infective endocarditis is a common disease with significant morbidity and mortality.


OBJECTIVE
To define clinical and echocardiographic parameters predicting morbidity and in-hospital mortality in patients with infective endocarditis hospitalized in a tertiary hospital from 1991 to 2000.


METHODS
All patients with definite infective endocarditis diagnosed according to the Duke criteria were included. We examined relevant clinical features that might influence outcome.


RESULTS
The study group comprised 100 consecutive patients, 77 with native valve and 23 with prosthetic valve endocarditis. The overall in-hospital mortality rate was 8%. There was a higher mortality in the PVE group compared to the NVE group (13% vs. 7%, P = 0.07). The mortality rate in each group, with or without surgery, was not significantly different. Clinical predictors of mortality were older age and hospital-acquired endocarditis. The presence of vegetations and their size were significant predictors of major embolic events and mortality. Staphylococcus aureus was a predictor of mortality (25% vs. 5%, P < 0.005) and abscess formation. Multivariate logistic analysis identified vegetation size and S. aureus as independent predictors of mortality.


CONCLUSIONS
Mortality is higher in older hospitalized patients. S. aureus is associated with a poor outcome. Vegetation size is an independent predictor of embolic events and of a higher mortality.
Gotsman
Israel
I
Heart Institute, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. igotsman@bezeqint.net
Meirovitz
Amichay
A
Meizlish
Nilli
N
Gotsman
Mervyn
M
Lotan
Chaim
C
Gilon
Dan
D
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D012307:Risk Factors