title: Clinical spectrum, presentation, and risk factors for mortality in infective endocarditis: a review of 68 cases at a tertiary care center in Turkey.
abstract: OBJECTIVE
  This study was designed to evaluate clinical, laboratory, microbiological, and echocardiographic characteristics of infective endocarditis (IE) at a tertiary care center in Turkey and to identify predictors of in-hospital mortality.
  
  
  METHODS
  Based on a systematic retrospective review of clinical records covering 1997 to 2007, we analyzed data and outcomes of 68 patients (40 males, 28 females; mean age 51+/-20 years) with definite or possible IE according to the modified Duke criteria.
  
  
  RESULTS
  Native valve endocarditis (NVE) was seen in 28 patients (41.2%), and prosthetic valve endocarditis (PVE) was seen in 38 patients (55.9%). Pacemaker endocarditis (PE) was observed in only two patients (2.9%). Nineteen patients (27.9%) had nosocomial IE. The most frequent predisposing factor for NVE was rheumatic heart disease (n=11; 39.3%). Echocardiography failed to show any signs of involvement in five patients (13.2%) with PVE. The most common causative microorganisms of NVE, PVE, and PE were staphylococci (n=28; 41.2%). At least one complication developed in 46 patients (67.7%), congestive heart failure being the most common (n=38; 55.9%). Forty-one patients (60.3%) underwent combined medical and surgical treatment. In-hospital mortality occurred in 17 patients (25%). Mortality rates were 37.5%, 30%, and 14.3% for early and late PVE and NVE, respectively. Mortality was significantly higher with nosocomial IE (57.9%) compared to 12.2% in the remaining patients. In multivariate analysis, septic shock (p=0.011) and nosocomial infection (p=0.032) were independently associated with in-hospital mortality.
  
  
  CONCLUSIONS
  Compared to the European series, IE in our cohort occurred in a relatively younger population, with rheumatic heart disease as the most common underlying heart disease. The rates of PVE, nosocomial IE, and surgical treatment were about the same.
authors.affiliation: Department of Cardiology, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey.
authors.forename: Aylin
authors.initials: A
authors.lastname: Tuğcu
authors.forename: Ozlem
authors.initials: O
authors.lastname: Yildirimtürk
authors.forename: Corç
authors.initials: C
authors.lastname: Baytaroğlu
authors.forename: Hilal
authors.initials: H
authors.lastname: Kurtoğlu
authors.forename: Ozkan
authors.initials: O
authors.lastname: Köse
authors.forename: Murat
authors.initials: M
authors.lastname: Sener
authors.forename: Saide
authors.initials: S
authors.lastname: Aytekin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D003428:Cross Infection / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000150:complications / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications / Q000401:mortality; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein