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© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background: This study aims to evaluate the impact of critical illness, defined as the need for preoperative intensive care unit (ICU) admission for invasive monitoring or organ support, on cardiac surgery outcomes for patients with acute infective endocarditis (IE). Methods: A retrospective analysis of prospectively collected data from patients treated between 1 January 2017 and 30 May 2024 at a single Australian tertiary cardiothoracic centre was performed. Data were collected from the Australian and New Zealand Cardiothoracic Society (ANZCTS) database and the Australian and New Zealand Intensive Care Adult Patients Database (ANZICS-APD). Results: Among 342 patients who underwent cardiac surgery for IE, 32 (9.4%) were critically ill. The critically ill patients were admitted to the ICU before surgery with a diagnosis of septic or cardiogenic shock, with 86% (n = 30) requiring mechanical ventilation. Compared to the non-critically ill cohort, critically ill patients were more likely to have a history of intravenous drug use (IVDU) (41% vs. 14%, p = 0.03) and a younger age (median age 49 years [42–56] vs. 61 years [44–70], p = 0.03), and although methicillin-sensitive Staphylococcus aureus (MSSA) was the most common causative organism in both groups, it was found significantly more often in the critically ill cohort (66% and 27%, p = 0.001). The median EuroSCORE II was comparable between the groups (2.1 [1.3–10] vs. 2.8 [1.3–5.7], p = 0.69); however, the APACHE III (57 [49–78] vs. 52 [39–67], p = 0.03) and ANZROD scores (0.04 [0.02–0.09] vs. 0.013 [0.004–0.038], p = 0.00002) were significantly higher in the critically ill patients. The overall 30-day mortality rates were similar between the groups (13% vs. 5%, p = 0.60). The median ICU length of stay (LOS) was significantly longer for the critically ill patients (5 days [IQR 2–10 days] vs. 2 days [1–4 days], p = 0.0004), with a similar hospital LOS (23 days [IQR 14–36] vs. 21 days [12–34], p = 0.46). Renal replacement therapy was three times higher in the critically ill (34% vs. 11%, p = 0.0001). Reoperations for bleeding were similar between the groups (16% vs. 11%, p = 0.74). Conclusions: Despite being associated with higher ANZROD and APACHE III scores, a longer ICU length of stay, and higher use of renal replacement therapy, critical illness did not have an impact on the EuroSCORE II, hospital length of stay, or reoperation rates for bleeding or 30-day mortality among patients with IE undergoing cardiac surgery. The lessons from this study will guide and inform the development of better infective endocarditis databases and registries.

Details

Title
The Impact of Critical Illness on the Outcomes of Cardiac Surgery in Patients with Acute Infective Endocarditis
Author
Matebele, Mbakise P 1 ; Vemuri, Kanthi R 2 ; Sedgwick, John F 2   VIAFID ORCID Logo  ; Marshall, Lachlan 2 ; Horvath, Robert 2 ; Obonyo, Nchafatso G 3 ; Ramanan Mahesh 4   VIAFID ORCID Logo 

 Metro North Hospital and Health Services, Queensland Health, Brisbane, QLD 4032, Australia; [email protected] (M.P.M.); [email protected] (K.R.V.); [email protected] (J.F.S.); [email protected] (L.M.); [email protected] (R.H.); [email protected] (N.G.O.), Mayne Medical School, The University of Queensland, Brisbane, QLD 4006, Australia, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4215, Australia, Critical Care Research Group, Brisbane, QLD 4032, Australia 
 Metro North Hospital and Health Services, Queensland Health, Brisbane, QLD 4032, Australia; [email protected] (M.P.M.); [email protected] (K.R.V.); [email protected] (J.F.S.); [email protected] (L.M.); [email protected] (R.H.); [email protected] (N.G.O.), Mayne Medical School, The University of Queensland, Brisbane, QLD 4006, Australia 
 Metro North Hospital and Health Services, Queensland Health, Brisbane, QLD 4032, Australia; [email protected] (M.P.M.); [email protected] (K.R.V.); [email protected] (J.F.S.); [email protected] (L.M.); [email protected] (R.H.); [email protected] (N.G.O.), Mayne Medical School, The University of Queensland, Brisbane, QLD 4006, Australia, Critical Care Research Group, Brisbane, QLD 4032, Australia 
 Metro North Hospital and Health Services, Queensland Health, Brisbane, QLD 4032, Australia; [email protected] (M.P.M.); [email protected] (K.R.V.); [email protected] (J.F.S.); [email protected] (L.M.); [email protected] (R.H.); [email protected] (N.G.O.), Queensland University of Technology, Brisbane, QLD 4059, Australia, The George Institute for Global Health, University of New South Wales, Sydney, NSW 2000, Australia 
First page
15
Publication year
2025
Publication date
2025
Publisher
MDPI AG
e-ISSN
26733846
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3223900035
Copyright
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.