• Eur. J. Intern. Med. · Dec 2021

    Observational Study

    Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients.

    • Emanuele Durante-Mangoni, Giuseppe Giuffrè, Maria Paola Ursi, Domenico Iossa, Lorenzo Bertolino, Alessandra Senese, Pia Clara Pafundi, Fabiana D'Amico, Rosina Albisinni, and Rosa Zampino.
    • Departments of Precision Medicine, Univeristy of Perugia; Unit of Infectious & Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy. Electronic address: emanuele.durante@unicampania.it.
    • Eur. J. Intern. Med. 2021 Dec 1; 94: 27-33.

    IntroductionVery limited data are available on the long-term outcome of infective endocarditis (IE) and its determinants. The aim of this study was to identify the predictors of long-term mortality in patients affected by left sided IE (LSIE).MethodsThis was an historical retrospective observational study on prospectively collected data from patients with LSIE hospitalized in our Unit (January 2000-December 2017). Multiple variables relevant to history, physical examination, laboratory tests, echocardiography, comorbidities, complications and outcome were analysed by Cox regression to identify predictors of long-term mortality.Results414 patients were included, and followed up for a median of 39 months [IQR 11-74]. Median age was 59 years [range 3-89], and most patients were male. Over 50% showed at least one comorbidity. Hyperglycaemia, increased creatinine and an indication for surgery predicted in-hospital mortality, while a prior myocardial infarction, chronic kidney disease (CKD) on hemodialysis and a larger vegetation were independent predictors of 1-year mortality. At multivariate analysis, peripheral arterial disease (p= 0.017), hyperglycemia on admission (p=0.013) and a higher BMI (p=0.009) were independent predictors of long-term mortality in 1-year survivors. At multivariable Cox proportional hazard regression, peripheral arterial disease (p=0.002), hyperglycemia (p=0.041) and CKD on hemodialysis (p=0.025) confirmed to be independently associated with an increased risk of long-term mortality in the overall 414 patient cohort.ConclusionsCardiovascular and metabolic risk signals, specifically peripheral arterial disease and hyperglicemia, affect long-term mortality of LSIE. An active and long-term follow up seems warranted in IE survivors showing these conditions at outset.Copyright © 2021. Published by Elsevier B.V.

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