title: Infective endocarditis in a tertiary referral hospital: long-term follow up.
abstract: OBJECTIVE
  Infective endocarditis (IE) is associated with significant mortality and morbidity. The aim of the present study was to assess the long-term survival of patients with IE, and to assess objectively the mortality in these patients by comparing their survival with that of an age- and gender-matched sample of the general population.
  
  
  METHODS
  A retrospective observational cohort study of adults with IE, as determined by the modified Duke criteria, was admitted to a tertiary referral center between January 1998 and December 2007. Cumulative survival was analyzed using the Kaplan-Meier method. The log-rank test was used to compare the different groups, and multivariate Cox proportional hazards regression analyses were carried out to identify predictors of long-term, all-cause mortality.
  
  
  RESULTS
  A total of 191 consecutive patients with IE was evaluated (176 left-sided, 15 right-sided). Cardiac surgery was performed in 72% of cases, and the median follow up was 6.3 years. The cumulative long-term survival was 59% after 10 years of follow up, the main causes of death being congestive heart failure (28%) and different type of malignancy (17%). Age- and gender-matched survival in the general population was 98%, 92%, and 80% after follow up periods of one, five, and ten years, respectively. The main predictor of long-term mortality was cancer, while surgery had a positive effect on long-term survival.
  
  
  CONCLUSIONS
  Despite diagnostic and therapeutic advances, IE is associated with a high long-term mortality. Compared to the general Dutch population, the survival of patients with IE was significantly lower. Even in the event of IE being cured, the survival of these patients may be diminished compared to that of the general population. Hence, a careful follow up of these patients is warranted.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. m.mokhles@erasmusmc.nl
authors.forename: M Mostafa
authors.initials: MM
authors.lastname: Mokhles
authors.forename: Isabella
authors.initials: I
authors.lastname: Ciampichetti
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Jin Ming
authors.initials: JM
authors.lastname: Cheng
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: Maarten
authors.initials: M
authors.lastname: Witsenburg
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D002423:Cause of Death; D015897:Comorbidity; D004696:Endocarditis / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013995:Time