title: Prognostic factors in infective endocarditis in general hospitals in the Netherlands.
abstract: BACKGROUND
  Despite advances in treatment, infective endocarditis (IE) still ranks amongst the most lethal infectious diseases. We sought to determine prognostic factors in general hospitals in the Netherlands as research in this setting is scarce.
  
  
  RESULTS
  Between 2004 and 2011, we identified 216 cases of IE, 30.1 % of which were prosthetic valve IE. This leads to an annual incidence of IE of 5.7 new cases per 100,000 persons per year. Women were less likely to undergo surgical intervention (OR = 1.96, 95 % CI 1.06-3.61, p = 0.031). Also, ageing was an independent prognostic factor for not receiving surgery in a multivariate analysis (annual OR = 1.04, 95 % CI 1.02-1.06, p < 0.001). Female sex was a prognostic factor for mortality (OR = 2.35, 95 % CI 1.29-4.28, p = 0.005). Age was also an independent prognostic factor for mortality (OR = 1.05, 95% CI 1.03-1.08, p < 0.001). Conservative treatment was a prognostic factor for mortality (OR = 3.39, 95 % CI 1.80-6.38, p < 0.001) whereas surgical intervention was an independent prognostic factor for adverse events (OR = 3.03, 95% CI 1.64-5.55, p < 0.001). Staphylococcus aureus was an independent prognostic factor for adverse events (OR = 2.05, 95 % CI 1.10-3.84, p = 0.024) but not for mortality.
  
  
  CONCLUSIONS
  This study shows that endocarditis in general hospitals has a high rate of morbidity and mortality. Even when treated, it ranks as one of the most lethal infectious diseases in the Netherlands, especially in women and the elderly.
authors.affiliation: Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands. floris.s.van.den.brink@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: van den Brink
authors.affiliation: Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Hasenaar
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Winia
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Klomp
authors.affiliation: Department of Cardiology, Kennemer Gasthuis, Haarlem, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Van Vlies
authors.affiliation: Department of Cardiology, Gelre Hospital, Apeldoorn, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Nicastia
authors.affiliation: Department of Cardiology, Gelre Hospital, Apeldoorn, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Groenmeijer
authors.affiliation: Department of Cardiology, Gelre Hospital, Apeldoorn, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Braam
authors.affiliation: Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Jaarsma
authors.affiliation: Department of Cardiology, Kennemer Gasthuis, Haarlem, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Funke Kupper
keywords: Endocarditis; Hospitals, general; Morbidity; Mortality; Staphylococcus aureus; Survival analysis