engleski

Prospective follow-up of patients with endocarditis - it does move after all!

One-hundred-eight consecutive patients with endocarditis were evaluated to assess risk factors for early lethal outcome. The following variables were retrieved from the medical records: a) general patient's characteristics such as age, gender, chronic diseases, previous heart disease ; b) clinical presentation (severe sepsis with multiple organ dysfunction and/or shock, respiratory failure requiring mechanical ventilation), duration of illness until the diagnosis of IE, duration of hospitalisation, duration of fever (>37.5°C) after the start of appropriate antimicrobial therapy, type of affected valve, localisation, specification of major and minor Duke criteria ; c) complications such as central nervous affection, cardiac failure, embolisations ; d) interventions (type and duration of antimicrobial therapy, timing of appropriate antimicrobial therapy, need for mechanical ventilation, surgical procedure) ; e) in-hospital outcome. Twenty-seven of 108 patients died during hospitalisation. Univariate analysis identified severity of sepsis characterised by the presence of MODS and/or septic shock, respiratory failure requiring mechanical ventilation, development of cardiac failure, S. aureus infection, absence of vegetations and CNS complications as factors associated with increased risk of death. The multivariate forward stepwise logistic regression analysis identified respiratory failure needing mechanical ventilation (p=0, 0001) and cardiac failure (p=0.0388) as significant independent predictors of a fatal outcome. Multiorgan dysfunction syndrome, particularly acute respiratory failure needing mechanical ventilation as well as cardiac failure significantly increase risk of death in patients with infective endocarditis. Better and close collaboration with cardio surgeons with optimal timing of valve replacement leads to better patients' outcome.

endocarditis

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