title: Active infective endocarditis: Clinical characteristics and factors related to hospital mortality.
abstract: BACKGROUND
  Little information exists on the clinical characteristics and factors related to hospital mortality in patients with active infective endocarditis referred for surgery.
  
  
  METHODS
  Between January 1, 2003 and December 31, 2006, 86 patients (56 males, 30 females, mean age 59.2 years) with active infective endocarditis were referred to our Department (2.8% of overall hospitalizations). The relation of several clinical, laboratory and echocardiographic findings at admission with hospital mortality was evaluated.
  
  
  RESULTS
  A native valve (NVE) was involved in 50/86; the other 30 had a prosthetic valve endocarditis (PVE). Six had pacemaker endocarditis. The aortic valve was involved more frequently than the mitral valve, both in NVE and PVE. The tricuspid valve was involved in four drug addicts; 51% of patients were in NYHA class III-IV. Staphylococci and streptococci were isolated in 69% of patients (39% vs 30%). Blood cultures were negative in 24%. Overall hospital mortality has been 11.6%. Two patients died before surgery, eight in the perioperative period. Hospital mortality was closely related to age, clinical and laboratory evidence of advanced septic condition (temperature > 38°C, leukocytosis and creatinine > 2.0 mg/dL) and hemodynamic impairment.
  
  
  CONCLUSIONS
  Active infective endocarditis is a significant cause of referral to heart surgery departments and hospital mortality is still > 10%. Clinical and laboratory parameters easily available at admission suggest that severe sepsis and/or hemodynamic impairment may be helpful in predicting the clinical outcome in this group of high risk patients.
authors.affiliation: Dipartimento Area Critica, Università di Firenze, Italy. c.rostagno@katamail.com
authors.forename: Carlo
authors.initials: C
authors.lastname: Rostagno
authors.forename: Gabriele
authors.initials: G
authors.lastname: Rosso
authors.forename: Francesco
authors.initials: F
authors.lastname: Puggelli
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.forename: Lucio
authors.initials: L
authors.lastname: Braconi
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Montesi
authors.forename: Stefano
authors.initials: S
authors.lastname: Romagnoli
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Stefano
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality* / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006351:Heart Valves / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality* / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome