Early Predictors of In-Hospital Death in Infective Endocarditis
Abstract
Background— Data on early determinants of outcome in infective endocarditis (IE) are limited. We evaluated the prognostic significance of early clinical characteristics in a large, prospective cohort of patients with IE. Methods and Results— Two hundred sixty-seven consecutive patients with definite or possible IE by modified Duke criteria and echocardiography performed within 7 days of presentation were evaluated. Acute physiology was assessed by the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score at the time of presentation, and early heart failure was diagnosed by Framingham criteria. In-hospital mortality rate in the cohort was 19% and similar for patients with definite or possible IE (20% versus 16%, respectively; P =0.464). Independent predictors of death determined by logistic regression modeling were diabetes mellitus (OR 2.48; 95% CI, 1.24 to 4.96), Staphylococcus aureus as causative organism (OR, 2.06; 95% CI, 1.01 to 4.20), APACHE II score (OR, 1.07; 95% CI, 1.01 to 1.12), and embolic event (OR, 2.79; 95% CI, 1.15 to 6.80). Early echocardiographic findings of the Duke criteria were not predictive of death. Conclusions— Early in the course of IE, readily available clinical characteristics that reflect the host-pathogen interaction are predictive of in-hospital death. These factors may identify those patients with IE for more aggressive treatment.
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Extension of infective endocarditis beyond the valve annulus predicts a higher mortality rate, more frequent development of heart failure, and more frequent need for cardiac surgery.
“Extension of IE beyond the valve annulus predicts a higher mortality rate, more frequent development of heart failure, and more frequent need for cardiac surgery.284,297,298”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [284]
The Abstract (page unavailable) says early echocardiographic findings were not predictive of in-hospital death. Table 1 (page unavailable) reports no statistically significant association between abscess and death (OR 1.52; P=0.525), contrary to the claimed mortality prediction. The Discussion identifies perivalvular extension as an indication for surgery, but does not show that it predicts more frequent heart failure or surgery. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe traditional indication for valvular surgery for infective endocarditis to avoid embolization has been at least 2 major embolic events.
“The traditional indication for valvular surgery for IE to avoid embolization has been ≥2 major embolic events.284”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [284]
The Discussion (page unavailable in our copy) says recurrent embolic events are a recognized indication for surgery in infective endocarditis, which supports the idea of more than one event. It does not specify that the events must be major or state a formal threshold of at least two major events. (LLM, conf=0.86)
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- Authors
- Chu, V. H., Cabell, C. H., Benjamin, D. K., Kuniholm, E. F., Fowler, V. G., Engemann, J., Sexton, D. J., Corey, G. R., & Wang, A.
- Affiliations
- Duke Medical Center (US)
- Venue
- Circulation
- Published
- 2004-04-13
- Volume
- 109
- Issue
- 14
- Pages
- 1745-1749
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2061453535
- Cited by
- 429
- References
- 33
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 22 · 2023: 14 · 2022: 22 · 2021: 20 · 2020: 18 · 2019: 22 · 2018: 25 · 2017: 13 · 2016: 18 · 2015: 19 · 2014: 30 · 2013: 15 · 2012: 21
- FWCI
- 16.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R03HD042940, R03HD42940-01)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- infective endocarditis, in-hospital mortality, prognostic factors, APACHE II score, diabetes mellitus, Staphylococcus aureus, embolic events, early heart failure, modified Duke criteria, echocardiographic findings, host-pathogen interaction
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Embolism, Endocarditis, Bacterial, Female, Heart Valves, Humans, Male, Middle Aged, Multiple Organ Failure, North Carolina, Prognosis, Prospective Studies, Risk Factors, Staphylococcal Infections, Ultrasonography, Cohort Studies, Comorbidity, Hospital Mortality, APACHE
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