Contemporary epidemiology and prognosis of septic shock in infective endocarditis.
OBJECTIVE
The prognosis of patients with infective endocarditis (IE) remains poor despite the great advances in the last decades. One of the factors closely related to mortality is the development of septic shock (SS). The aim of our study was to describe the profile of patients with IE complicated with SS, and to identify prognostic factors of new-onset SS during hospitalization.


RESULTS
We conducted a prospective study including 894 episodes of IE diagnosed at three tertiary centres. A backward logistic regression analysis was undertaken to determine prognostic factors associated with SS development. Multivariable analysis identified the following as predictive of SS development: diabetes mellitus [odds ratio (OR) 2.06; confidence interval (CI) 1.16-3.68], Staphylococcus aureus infection (OR: 2.97; CI: 1.72-5.15), acute renal insufficiency (OR: 3.22; CI: 1.28-8.07), supraventricular tachycardia (OR: 3.29; CI: 1.14-9.44), vegetation size ≥15 mm (OR: 1.21; CI: 0.65-2.25), and signs of persistent infection (OR: 9.8; CI: 5.48-17.52). Risk of SS development could be stratified when combining the first five variables: one variable present: 3.8% (CI: 2-7%); two variables present: 6.3% (CI: 3.2-12.1%); three variables present: 14.6% (CI: 6.8-27.6%); four variables present: 29.1% (CI: 11.7-56.1%); and five variables present: 45.4% (95% CI: 17.5-76.6%). When adding signs of persistent infection, the risk dramatically increased, reaching 85.7% (95% CI: 61.2-95.9%) of risk.


CONCLUSIONS
In patients with IE, the presence of diabetes, acute renal insufficiency, Staphylococcus aureus infection, supraventricular tachycardia, vegetation size ≥15 mm, and signs of persistent infection are associated with the development of SS.
Instituto Cardiovascular, Hospital Clínico de San Carlos, Prof. Martín Lagos s/n, 28040 Madrid, Spain.
Carmen
C
Olmos
Isidre
I
Vilacosta
Cristina
C
Fernández
Javier
J
López
Cristina
C
Sarriá
Carlos
C
Ferrera
Ana
A
Revilla
Jacobo
J
Silva
David
D
Vivas
Isabel
I
González
José Alberto
JA
San Román
D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality; D003428:Cross Infection / Q000150:complications / Q000401:mortality; D048909:Diabetes Complications / Q000150:complications / Q000401:mortality; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications / Q000401:mortality*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications / Q000401:mortality*; D013203:Staphylococcal Infections / Q000150:complications / Q000401:mortality*; D013211:Staphylococcus aureus; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000401:mortality