title: Clinical profile, prognosis and treatment of patients with infective endocarditis--a 14-year follow-up study.
abstract: BACKGROUND
  Poor prognosis of infective endocarditis (IE) is not only attributable to high morbidity and mortality during an active phase of the disease, but also to late complications and relapses occurring after eradication of the infection. Identification of unfavorable prognostic factors allows to optimize therapeutic modalities in patients with particularly poor prognosis.
  
  
  OBJECTIVE
  To determine clinical features and long-term prognosis among patients with IE.
  
  
  METHODS
  The study group consisted of 69 IE patients hospitalized in our center between 1992 and 2005. The diagnosis of IE was based on the Duke University criteria. The mean age was 52 +/- 12 years. Surgical treatment was performed in 48 (70%) cases.
  
  
  RESULTS
  The etiology of IE was Staphylococcus sp. in 32% of patients, Streptococcus sp. in 16% of patients, in 41% of cases blood cultures were negative. The infection was located on the aortic (43%), mitral (26%), tricuspid (8%) and multiple valves (20%). During 1-14 years of follow-up, 27 patients died (39%). Prognostic factors included NYHA class of heart failure (p = 0.031), lower left ventricular ejection fraction (p = 0.017), kidney failure (p = 0.012), atrial fibrillation (p = 0.006), a history of rheumatic valve disease (p = 0.046). In multivariate logistic analysis the only significant parameter related to poor prognosis after IE was atrial fibrillation. The analysis of receiver operating characteristic curve showed that patients with atrial fibrillation were significantly associated with higher mortality (HR 5.35, 95% CI 1.47-19.56, p = 0.011).
  
  
  CONCLUSIONS
  Regardless of the mode of treatment (medical or combined medical-surgical), the mortality of patients with infective endocarditis remains relatively high. In this study atrial fibrillation seems to be the most important risk factor of death.
authors: 2nd Chair and Department of Cardiology, Medical University of Lodz, Poland. rkrecki@gazeta.pl
authors: Radoslaw
authors: R
authors: Krecki
authors: Jaroslaw
authors: J
authors: Drozdz
authors: Georges
authors: G
authors: Ibata
authors: Piotr
authors: P
authors: Lipiec
authors: Stanislaw
authors: S
authors: Ostrowski
authors: Jaroslaw
authors: J
authors: Kasprzak
authors: Maria
authors: M
authors: Krzeminska-Pakula
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000628:therapy*; D013290:Streptococcal Infections / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome