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- Title
Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry.
- Authors
Ramos-Martínez, Antonio; Domínguez, Fernando; Muñoz, Patricia; Marín, Mercedes; Pedraz, Álvaro; Fariñas, Mª Carmen; Tascón, Valentín; de Alarcón, Arístides; Rodríguez-García, Raquel; Miró, José María; Goikoetxea, Josune; Ojeda-Burgos, Guillermo; Escrihuela-Vidal, Francesc; Calderón-Parra, Jorge
- Abstract
Background: Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. Methods: Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. Results: The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62–77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008–2013 and 29.9% in 2014–2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08–1.23), intracardiac abscess (OR:1.78, 95% CI:1.30–2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31–4.19), acute renal failure (OR: 3.11, 95% CI:1.14–2.09), septic shock (OR: 5.56, 95% CI:3.55–8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21–2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49–2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke. Conclusions: Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
- Subjects
PROGNOSIS; BACTEREMIA; SYMPTOMS; SEPTIC shock; ENDOCARDITIS; ACUTE kidney failure; HOSPITAL mortality; ARACHNOID cysts
- Publication
PLoS ONE, 2023, Vol 18, Issue 9, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0290998