title: Left-sided infective endocarditis: analysis of in-hospital and medium-term outcome and predictors of mortality.
abstract: BACKGROUND
  Despite diagnostic and therapeutic advances, infective endocarditis (IE) remains a challenging and potentially lethal disease. The prognosis of IE remains poor; in the last 30 years, its incidence and mortality have only been marginally reduced. Early identification of high-risk patients can change the course of the disease and improve outcomes.
  
  
  OBJECTIVE
  To describe and investigate predictors of mortality during hospital stay and in the six months after discharge in a cohort of left-sided IE patients in two tertiary centers. All patients diagnosed with IE (ICD9 code 133) were registered in a uniform database.
  
  
  RESULTS
  One hundred and forty-seven consecutive case patients with left-sided IE were included in this study. Thirty-five patients (23.8%) died during hospital stay. The variables significantly associated with increased mortality in univariate analysis were Charlson index ≥ 5, use of immunosuppressants, sepsis (severe sepsis and/or septic shock), cardiogenic shock and inappropriate use of antibiotic therapy. Conversely, surgical therapy and hospital length of stay ≥ 30 days were significantly associated with lower mortality. In multivariate analysis the most important predictors of in-hospital mortality were sepsis (severe and/or shock), use of immunosuppressants and inappropriate use of antibiotic therapy. There was a significant relation between the use of immunosuppressants and the occurrence of sepsis. The presence of significant valve disease after IE significantly increased the risk of heart failure.
  
  
  CONCLUSIONS
  Our results may help to identify IE patients at increased risk for in-hospital mortality and medium-term disability. These findings can help to identify candidates for earlier and more aggressive management.
authors.affiliation: Internal Medicine and Cardiology Departments, Centro Hospitalar do Porto, Porto, Portugal; Internal Medicine Department, Centro Hospitalar de São João, Porto, Portugal. Electronic address: jp7ferreira@hotmail.com.
authors.forename: João Pedro
authors.initials: JP
authors.lastname: Ferreira
authors.forename: Filipa
authors.initials: F
authors.lastname: Gomes
authors.forename: Patrícia
authors.initials: P
authors.lastname: Rodrigues
authors.forename: Miguel
authors.initials: M
authors.lastname: Araújo Abreu
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Maia
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.forename: André
authors.initials: A
authors.lastname: Luz
authors.forename: Severo
authors.initials: S
authors.lastname: Torres
authors.forename: João
authors.initials: J
authors.lastname: Araújo Correia
mesh_terms: D000368:Aged; D004697:Endocarditis, Bacterial / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
keywords: Analysis; Análise; Endocardite infecciosa; Infective endocarditis; Mortalidade; Mortality; Outcome; Prognóstico