title: Risk factors for in-hospital mortality in infective endocarditis: five years' experience at a tertiary care hospital in Turkey.
abstract: OBJECTIVE
  Despite recent improvements in diagnostic and therapeutic interventions, infective endocarditis (IE) is still associated with high in-hospital mortality rates. The study aim was to determine the clinical, laboratory and echocardiographic features of IE, and to evaluate the risk factors for in-hospital mortality.
  
  
  METHODS
  A retrospective cohort study design was employed, with a main outcome measure of in-hospital mortality. A total of 107 patients (79 males, 28 females; mean age 45 +/- 16 years) admitted with the modified Duke criteria for definitive IE were included in the study during a five-year period between January 2004 and December 2008.
  
  
  RESULTS
  Among the patients, the mitral valve alone was involved in 45% of cases, the aortic valve in 36%, tricuspid valve in 11%, and multiple valves in 8%. Forty-seven patients (44%) had prosthetic valves. Blood cultures were positive in 71 patients (66%). The most common isolated microorganisms were staphylococci, streptococci and Brucella melitensis. The in-hospital mortality rate was 27%. Leading causes of death were multi-organ failure and heart failure. In univariate analysis, factors associated with death were a longer duration of symptoms before hospitalization, previous history of IE, white blood cell count > or = 10,000/mm3, serum creatinine level > or = 2 mg/dl, vegetation size >15 mm, involvement of multiple valves, existence of severe regurgitation, cardiac abscess, and neurologic complications. Multivariate analysis showed that risk factors for mortality were multivalvular involvement (hazard ratio (HR) 4.7; 95% confidence interval (CI) 1.3-17.6; p = 0.021), vegetation size >15 mm (HR 5.5; 95% CI 2.1-14.6; p = 0.001), serum creatinine > or = 2 mg/dl (HR 4.1; 95% CI 1.8-9.4; p = 0.001), and previous history of IE (HR 3.5; 95% CI 1.2-11; p = 0.026).
  
  
  CONCLUSIONS
  Multivalvular involvement, vegetation length >15 mm, serum creatinine level > or = 2 mg/dl on admission, and a previous history of IE, were independent predictors for in-hospital mortality in IE.
authors.affiliation: Department of Cardiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey. aerbay@ttmail.com
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Erbay
authors.forename: Ayşe
authors.initials: A
authors.lastname: Erbay
authors.forename: Aytun
authors.initials: A
authors.lastname: Canga
authors.forename: Gökhan
authors.initials: G
authors.lastname: Keskin
authors.forename: Nihat
authors.initials: N
authors.lastname: Sen
authors.forename: Ramazan
authors.initials: R
authors.lastname: Atak
authors.forename: Ahmet Duran
authors.initials: AD
authors.lastname: Demir
authors.forename: Yücel
authors.initials: Y
authors.lastname: Balbay
authors.forename: Erdal
authors.initials: E
authors.lastname: Duru
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult