Impact of the initial clinical presentation on the outcome of patients with infective endocarditis

Abstract

BACKGROUND: Infective endocarditis (IE) is a life-threatening disease. Despite advancements in diagnostic
methods, the initial clinical presentation of IE remains a valuable asset. Therefore, the impact
of clinical presentation on outcomes and its association with microorganisms and IE localization were
assessed herein.
METHODS: This retrospective study included 183 patients (age 68.9 ± 14.2 years old, 68.9% men)
with definite IE at two tertiary care hospitals in Belgium. Demographic data, medical history, clinical
presentation, blood cultures, imaging data and outcomes were recorded.
RESULTS: In-hospital mortality rate was 22.4%. Sixty (32.8%) patients developed embolism, 42 (23%)
shock, and 103 (56.3%) underwent surgery during hospitalization. Shock at admission predicted
embolism during hospitalization (odds ratio [OR] 2.631, 95% confidence interval [CI] 1.119–6.184,
p = 0.027). A new cardiac murmur at admission predicted cardiac surgery (OR 1.949, 95% CI 1.007–
–3.774, p = 0.048). Methicillin resistant Staphylococcus aureus predicted in-hospital mortality and
shock (p = 0.005, OR 6.945, 95% CI 1.774–27.192 and p = 0.015, OR 4.691, 95% CI 1.348–16.322,
respectively). Mitral valve and aortic valve IE predicted in-hospital death (p = 0.039, OR 2.258, 95%
CI 1.043–4.888) and embolism (p = 0.017, OR 2.328, 95% CI 1.163–4.659), respectively.
CONCLUSIONS: In this retrospective study, shock at admission independently predicted embolism during
hospitalization in IE patients. Moreover, a new cardiac murmur at admission predicted the need
for cardiac surgery. This emphasizes the importance of a comprehensive initial clinical evaluation in
combination with imaging and microbiological data, in order to identify high-risk IE patients early.