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VOLUME 26 , ISSUE 8 ( August, 2022 ) > List of Articles


Infective Endocarditis as a Cause of Critical Illness, In-hospital Mortality, and Complications

Roqia D Ayad, Ashraf W Andraos, Khaled AE Taema, Ibraheem M Attia, Moamen Yehia

Keywords : Complications, Critical illness, Infective endocarditis, In-hospital mortality

Citation Information : Ayad RD, Andraos AW, Taema KA, Attia IM, Yehia M. Infective Endocarditis as a Cause of Critical Illness, In-hospital Mortality, and Complications. Indian J Crit Care Med 2022; 26 (8):930-934.

DOI: 10.5005/jp-journals-10071-24276

License: CC BY-NC 4.0

Published Online: 30-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Critical illness due to infective endocarditis (IE) has high in-hospital mortality. Besides being a cause of sepsis, this disease has the potential nature to affect multiple organs. Patients and methods: Data for 84 patients managed at the critical care medicine unit at Cairo University for 7 years were surveyed for IE using modified Dukes criteria. Among the patient group with a verified diagnosis of IE, patient characteristics (age and comorbidities), the grade of diagnosis, the blood culture result, echocardiographic findings, minor diagnostic signs (fever, presence of prosthetic valves and pacemaker, vascular phenomena, immunologic phenomena) and clinical complications (heart failure, septic shock, neurologic complications renal failure) were studied regarding their association to in-hospital mortality. Incidence of clinical complications was compared to the control group with sepsis due to other causes. Results: The mortality rate in the IE group is 18.8%. Factors showing significant association to in-hospital mortality are; septic shock p = 0.01, neurological complications p = 0.025 (especially cerebral hemorrhage p = 0.025), indicated non-performed surgery p = 0.008, and presence of underlying heart failure with reduced ejection fraction (HFrEF), p = 0.002. Incidence of clinical complications showed no significant difference in IE patients and patients with other causes of sepsis except heart failure which showed significantly increased incidence in the IE group, p = 0.004. Conclusion: Septic shock, neurological complications, indicated nonperformed surgery, and presence of underlying HFrEF are in-hospital mortality risk factors in critically ill patients due to IE. In-hospital mortality and clinical complication incidence (except heart failure) are similar to other causes of sepsis.

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  1. Thuny F, Grisoli D, Cautela J, Riberi A, Raoult D, Habib G. Infective endocarditis: prevention, diagnosis, and management. Can J Cardiol 2014;30(9):1046–1057. DOI: 10.1016/j.cjca.2014.03.042.
  2. Li JS, Sexton DJ, Mick N, Netles R, Fowler Jr VG, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000;30:633–663. DOI: 10.1086/313753.
  3. Karalis DG, Bansal RC, Hauck AJ, Ross J Jr, Applegate PM, Jutzy KR, et al. Transesophageal echocardiographic recognition of subaortic complications in aortic valve endocarditis. Circulation 1992;86(2): 353–362. DOI: 10.1161/01.cir.86.2.353.
  4. San Roman JA, Vilacosta I, Zamorano JL, Almeria C, Sanchez-Harguindey L. Transesophageal echocardiography in right-sided endocarditis. J Am Coll Cardiol 1993;21:1226–1230. DOI: 10.1016/0735-1097(93)90250-5.
  5. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL, Galderisi M, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr 2010;11(2):202–219. DOI: 10.1093/ejechocard/jeq004.
  6. Tornos P, Almirante B, Olona M, Permanyer G, González T, Carballo J, et al. Clinical outcome and long-term prognosis of late prosthetic valve endocarditis: a 20-year experience. Clin Infect Dis 1997;24(3):381–386. DOI: 10.1093/clinids/24.3.381.
  7. Selton-Suty C, Celard M, Le Moing V, Doco-Lecompte T, Chirouze C, Iung B, et al. Preeminence of Staphylococcus aureus in infective endocarditis: a 1-year population-based survey. Clin Infect Dis 2012;54(9):1230–1239. DOI: 10.1093/cid/cis199.
  8. Sy RW, Kritharides L. Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia. Eur Heart J 2010;31(15):1890–1897. DOI: 10.1093/eurheartj/ehq110.
  9. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2009;30(19):2369–2413. DOI: 10.1093/eurheartj/ehp285.
  10. Chu VH, Cabell CH, Benjamin Jr DK, Kuniholm EF, Fowler Jr VG, Engemann J, et al. Early predictors of in-hospital death in infective endocarditis. Circulation 2004;109(14):1745–1749. DOI: 10.1161/01.CIR.0000124719.61827.7F.
  11. García-Cabrera E, Fernández-Hidalgo N, Almirante B, Noureddine M, Plata A, Lomas JM, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation 2013;127(23): 2272–2284. DOI: 10.1161/CIRCULATIONAHA.112.000813.
  12. Heiro M, Helenius H, Hurme S, Savunen T, Metsärinne K, Engblom E, et al. Long-term outcome of infective endocarditis. Arch Intern Med 2000;160(18):2781. DOI: 10.1001/archinte.160.18.2781.
  13. Revilla A, López J, Vilacosta I, Villacorta E, Rollán MJ, Echevarría JR, et al. Clinical and diagnostic profile of patients with infective endocarditis. Eur Heart J 2007;28(1):65–71. DOI: 10.1093/eurheartj/ehl315.
  14. Moreira RI, Cruz MC, Branco LM, Galrinho A, Miranda LC, Fragata J, et al. Infective endocarditis: surgical management and prognostic predictors. Rev Port Cardiol (Engl Ed) 2018;37(5):387–394. DOI: 10.1016/j.repce.2017.08.007.16.
  15. Krecki R, Drozdz J, Ibata G, Lipiec P, Ostrowski S, Kasprzak J, et al. Clinical profile, prognosis and treatment of patients with infective endocarditis. Clin Infect Dis 2000;30(4):633–638. DOI: 10.20452/pamw.224.
  16. Cresti A, Chiavarelli M, Scalese M, Nencioni C, Valentini S, Guerrini F, et al. Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study. Cardiovasc Diagn Ther 2017;7(1). DOI: 10.21037/cdt.2016.08.09.
  17. Batoo AM, Waleed A, Sameh B, Wafaa E, Hussein R. Predictors of in hospital mortality in patients with infective endocarditis. Egypt Heart J 2013;65(3). DOI: 10.1016/j.ehj.2012.09.002.
  18. Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH, et al. Mortality from infective endocarditis: clinical predictors of outcome. BMC Infect Dis 2008;8:49. DOI: 10.1186/1471-2334-8-49.
  19. Gálvez-Acebal J, Rodríguez-Baño J, Martínez-Marcos FJ, Reguera JM, Plata A, Ruiz J, et al. Prognostic factors in left-sided endocarditis: results from the Andalusian multicenter cohort. BMC Infect Dis 2010;10:17. DOI: 10.1186/1471-2334-10-17.
  20. Alkhawam H, Sogomonian R, Zaiem F, Vyas N, El-Hunjul M, Jolly J, et al. Morbidity and mortality of infective endocarditis. Investig Med 2016;64(6):1118–1123. DOI: 10.1136/jim-2015-000040.22.
  21. Remadi JP, Habib G, Nadji G, Brahim A, Thuny F, Casalta JP, et al. Predictors of death and impact of surgery in Staphylococcus aureus infective endocarditis. Ann Thorac Surg 2007;83(4):1295–1302. DOI: 10.1016/j.athoracsur.2006.09.093.
  22. Olmos C, Vilacosta I, Fernández C, López J, Sarriá C, Ferrera C, et al. Contemporary epidemiology and prognosis of septic shock in infective endocarditis. Eur Heart J 2013;34(26):1999–2006. DOI: 10.1093/eurheartj/ehs336.
  23. Bishara J, Peled N, Samra Z, Sagie A, Leibovici L, Pitlik S. Infective endocarditis in diabetic and non-diabetic patients. Scand J Infect Dis 2004;36:795–798. DOI: 10.1080/00365540410025384.25.
  24. Calvet HM, Yoshikawa TT. Infections in diabetes. Infect Dis Clin North Am 2001;15(2):407–421. DOI: 10.1016/s0891-5520(05)70153-7.
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