title: Prognostic factors in left-sided endocarditis: results from the Andalusian multicenter cohort.
abstract: BACKGROUND
  Despite medical advances, mortality in infective endocarditis (IE) is still very high. Previous studies on prognosis in IE have observed conflicting results. The aim of this study was to identify predictors of in-hospital mortality in a large multicenter cohort of left-sided IE.
  
  
  METHODS
  An observational multicenter study was conducted from January 1984 to December 2006 in seven hospitals in Andalusia, Spain. Seven hundred and five left-side IE patients were included. The main outcome measure was in-hospital mortality. Several prognostic factors were analysed by univariate tests and then by multilogistic regression model.
  
  
  RESULTS
  The overall mortality was 29.5% (25.5% from 1984 to 1995 and 31.9% from 1996 to 2006; Odds Ratio 1.25; 95% Confidence Interval: 0.97-1.60; p = 0.07). In univariate analysis, age, comorbidity, especially chronic liver disease, prosthetic valve, virulent microorganism such as Staphylococcus aureus, Streptococcus agalactiae and fungi, and complications (septic shock, severe heart failure, renal insufficiency, neurologic manifestations and perivalvular extension) were related with higher mortality. Independent factors for mortality in multivariate analysis were: Charlson comorbidity score (OR: 1.2; 95% CI: 1.1-1.3), prosthetic endocarditis (OR: 1.9; CI: 1.2-3.1), Staphylococcus aureus aetiology (OR: 2.1; CI: 1.3-3.5), severe heart failure (OR: 5.4; CI: 3.3-8.8), neurologic manifestations (OR: 1.9; CI: 1.2-2.9), septic shock (OR: 4.2; CI: 2.3-7.7), perivalvular extension (OR: 2.4; CI: 1.3-4.5) and acute renal failure (OR: 1.69; CI: 1.0-2.6). Conversely, Streptococcus viridans group etiology (OR: 0.4; CI: 0.2-0.7) and surgical treatment (OR: 0.5; CI: 0.3-0.8) were protective factors.
  
  
  CONCLUSIONS
  Several characteristics of left-sided endocarditis enable selection of a patient group at higher risk of mortality. This group may benefit from more specialised attention in referral centers and should help to identify those patients who might benefit from more aggressive diagnostic and/or therapeutic procedures.
authors.affiliation: Infectious Diseases Section, University Hospital Virgen Macarena, Sevilla, Spain. jga3156@yahoo.es
authors.forename: Juan
authors.initials: J
authors.lastname: Gálvez-Acebal
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Martínez-Marcos
authors.forename: Jose M
authors.initials: JM
authors.lastname: Reguera
authors.forename: Antonio
authors.initials: A
authors.lastname: Plata
authors.forename: Josefa
authors.initials: J
authors.lastname: Ruiz
authors.forename: Manuel
authors.initials: M
authors.lastname: Marquez
authors.forename: Jose M
authors.initials: JM
authors.lastname: Lomas
authors.forename: Javier
authors.initials: J
authors.lastname: de la Torre-Lima
authors.forename: Carmen
authors.initials: C
authors.lastname: Hidalgo-Tenorio
authors.forename: Arístides
authors.initials: A
authors.lastname: de Alarcón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000150:complications / Q000209:etiology / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult