Introduction: The reported risk of mortality associated with Infective Endocarditis (IE) is in the region of 20%. Few studies have looked into the independent risk factors associated with such mortality. Those who did tended to have relatively small numbers of patients. In this study, we analyse the independent risk factors associated with IE mortality in a large cohort of Saudi patients.
Methods: This is a case-control retrospective analysis of prospectively collected admission data. Between 2007 and 2016, 430 patients were admitted with IE to a tertiary referral centre. Of those, 12 did not meet the modified Duke’s criteria and were excluded. 61 clinical and epidemiological data points were identified. Data was analysed using STATA 14.1. The Mantel-Haenszel estimates of odds ratios ((OR) (95%confidence interval)) for IE mortality were calculated correcting for age, gender and surgical intervention.
Results: Median(range) age was 40.6 (0.1-82.7) years and 52% were males. 43% had cardiac surgery during the same admission. There were 68 (16%) in hospital deaths. Significant associations with death were multiple valve IE 2.25 (1.04-4.84) p.032, Pseudomonas IE 2.73 (1.32-5.63) p .004, mixed organism IE 3.15 (1.44-6.88) p .002, negative blood culture 0.45(0.24-0.82) p .008, leucocytosis 1.81 (1.04-3.15) p .031, CKDIII-V 3.43 (1.89-6.22) p.000, hyponatremia 2.02 (1.15-3.54) p.012, thrombocytopenia 3.07 (1.68-5.6) p.000, anemia 2.29 (1.33-3.95) p.002 and vascular complications 2.1 (1.15-3.75) p.012. Mortality was not associated with synthetic/native valve IE, site of infection, presence or size of valvular thrombi, body mass index, or the intake of antiplatelets, anticoagulants, diuretics and B Blockers.
Conclusion: Mortality from Infective endocarditis remains high. In this cohort, the risk of death from IE appears to be mainly related to the severity of the initial infection burden and inflammatory response. Policies aiming at infection prevention and physiological optimization might reduce the overall mortality from this condition in our population.