title: Clinical and echocardiographic risk factors for embolism and mortality in infective endocarditis.
abstract: Data about predictors of embolism in patients with infective endocarditis (IE) are conflicting. This study aimed to investigate clinical and transoesophageal echocardiography (TEE) characteristics in predicting embolism and six-month mortality. In this observational cohort study, 216 patients with definite left-sided IE, according to the modified Duke criteria, were prospectively recruited. All patients underwent TEE. 'Any embolism' was defined as embolism before or after initiation of antimicrobial therapy; 'new embolism' included embolism after initiation of antimicrobial therapy. Sixty-two of 216 patients (29%) experienced any embolism. New embolism occurred in 12 patients (6%), 7 of which were postoperative. Factors significantly associated with any embolism were community origin of IE and the etiologic microorganism, in particular staphylococci and nonviridans streptococci. Vegetation length >10 mm showed a trend towards association with new embolism and a mobile vegetation was predictive for new embolism. Six-month mortality was 24% (52/216). In multivariable analysis, age, vegetation length >10 mm, Staphylococcus aureus, and the type of treatment predicted mortality. Multiple emboli showed a trend towards association with death. In conclusion, any embolism occurred in over a fourth of patients. A mobile vegetation was significantly associated with new embolism, and vegetation length >10 mm tended to be associated with new embolism. Vegetation length >10 mm predicted six-month mortality, and multiple emboli showed a trend towards association with death.
authors.affiliation: Department of Internal Medicine-Infectious Diseases, University Hospital Gasthuisberg K.U. Leuven, 3000, Leuven, Belgium.
authors.forename: Evelyn E
authors.initials: EE
authors.lastname: Hill
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.forename: Piet
authors.initials: P
authors.lastname: Claus
authors.forename: Steven
authors.initials: S
authors.lastname: Vanderschueren
authors.forename: Willy E
authors.initials: WE
authors.lastname: Peetermans
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Herregods
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000401:mortality*; D004696:Endocarditis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications; D013290:Streptococcal Infections / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents