title: Multiple-valve infective endocarditis: clinical, microbiologic, echocardiographic, and prognostic profile.
abstract: Whether infection in more than 1 valve worsens the prognosis for endocarditis remains untested. We conducted the current study to determine the profile of multiple-valve endocarditis, compare multiple-valve endocarditis with single-valve endocarditis, and determine predictors of outcome. We conducted a prospective and observational study including 680 episodes of infective endocarditis consecutively diagnosed at 3 tertiary centers. Multiple valve involvement was present in 115 episodes (17%), and single valve involvement in 530 (78%). In the remaining 35 cases, valvular involvement could not be documented. Mean age of patients with multiple valve endocarditis was 58 years. Clinical complications were frequent (heart failure 65%, renal failure 44%, systemic embolisms 24%). The microorganism most frequently isolated was Staphylococcus aureus (22%).Factors predictive of in-hospital mortality in the univariate analysis were septic shock, prosthetic endocarditis, heart failure, and persistent infection. In the multivariate analysis, we detected heart failure (odds ratios [OR], 4.7; 95% confidence interval [CI], 1.6-13.8) and persistent infection (OR, 4.3; 95% CI, 1.7-10.8) as predictors of in-hospital mortality. Compared to single-valve endocarditis, multiple-valve disease was associated more frequently with heart failure (65% vs. 50%, p = 0.03), perivalvular complications (41% vs. 21%, p < 0.001), and heart surgery (70% vs. 54%, p = 0.002). Despite these differences, in-hospital mortality was similar (28% vs. 30%, p = 0.647). In conclusion, multiple-valve endocarditis has a poor clinical course. Mortality is similar to that of single-valve endocarditis, probably in relation with aggressive therapy including surgery in many patients. Heart failure and persistent infection are independent predictors of death.
authors.affiliation: From Institute of Heart Sciences (ICICOR), University Clinic Hospital (JL,AR, TS, HG, IG, JASR), Valladolid; University Hospital San Carlos (IV,EP), Madrid; La Princesa Hospital (CS), Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Ana
authors.initials: A
authors.lastname: Revilla
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: Teresa
authors.initials: T
authors.lastname: Sevilla
authors.forename: Héctor
authors.initials: H
authors.lastname: García
authors.forename: Itziar
authors.initials: I
authors.lastname: Gómez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Pozo
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarriá
authors.forename: José Alberto
authors.initials: JA
authors.lastname: San Román
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000379:methods; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D015150:Echocardiography, Doppler / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents