Vol. 48 | No. 2 | July-December 2020 Back

Open Access

Clinical Outcome and Predictors of In-Hospital Mortality Among Patients With Infective Endocarditis at the Philippine Heart Center

Emily Mae L. Yap, Ana Beatriz D. Medrano, Raquel Victoria M. Ecarma
Dec 2020 DOI 10.69944/pjc.2b52b14145

Abstract

BACKGROUND: Infective endocarditis (IE) continues to be a fatal disease if inappropriately diagnosed or managed. This study aims to determine the clinical features, outcomes, and predictors of mortality among those with IE in our institution. 

METHODOLOGY: We retrospectively reviewed 283 patients in our institutional database for all cases of IE admitted and diagnosed as having definite and possible IE based on the modified Duke’s criteria between 2007 and 2016. Incidence, clinical course, and predictors of outcomes were analyzed.  

RESULTS: The 10-year prevalence rate of IE was 0.21%, with 21 cases of IE for every 10,000 person-days. The mean age was 40 ± 16.5 years, with a male predominance (59%). Fever (47%) and dyspnea (36%) were the most common clinical presentation. One-half of the patients received empiric antibiotics prior to admission. Blood cultures were negative in 62% of cases. Streptococcus species was the most common isolated organism. β-Lactams as monotherapy or in combination with aminoglycosides were the most common antibiotics given. Acute kidney injury (18%), septic shock (15%), and acute heart failure (12%) were the most common major adverse events during hospitalization. The in-hospital mortality rate was 30%. On multivariate analysis, positive blood culture (odds ratio [OR], 8.7; 95% confidence interval [CI], 1.68–45.26; p = 0.010), acute kidney injury (OR, 5.0; 95% CI, 1.04–24.15; p = 0.045), septic shock (OR, 2.58; 95% CI, 1.33–5.01; p = 0.005), and surgical management for an emergent or urgent indication (OR, 0.22; 95% CI, 0.05–0.90) were independent predictors of mortality. 

CONCLUSION: Infective endocarditis continues to be associated with significant morbidity and mortality. The results of this study underscore the need to identify patients who are at high risk of complications as well as more aggressive medical and surgical management to improve outcomes. 

KEYWORDS: infective endocarditis, native valve endocarditis, prosthetic valve endocarditis valves

 

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