Infective endocarditis: Absence of microbiological diagnosis is an independent predictor of inhospital mortality

• Published in: International journal of cardiology Vol. 220; pp. 162 - 165
• Main Authors: Díez-Villanueva, Pablo, Muñoz, Patricia, Marín, Mercedes, Bermejo, Javier, de Alarcón González, Arístides, Fariñas, María Carmen, Gutiérrez-Cuadra, Manuel, Pericás-Pulido, Jose Manuel, Lepe, José Antonio, Castelo, Laura, Goenaga, Miguel Ángel, Ruiz-Morales, Josefa, Tarabini, Paola, Martínez-Sellés, Manuel
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 01-10-2016
• Subjects: Aged; Blood culture-negative endocarditis; Cardiovascular; Cohort Studies; Endocarditis - diagnosis; Endocarditis - microbiology; Endocarditis - mortality; Female; Hospital Mortality; Humans; Infective endocarditis; Male; Microbiological Techniques - methods; Microbiological Techniques - statistics & numerical data; Middle Aged; Mortality; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment - methods; Spain - epidemiology; blood culture-negative endocarditis; mortality; infective endocarditis; prognosis; Blood culture-negative endocarditis; Infective endocarditis; Prognosis; Mortality
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.06.129

Abstract Background Infective endocarditis (IE) is associated with high inhospital mortality. New microbiological diagnostic techniques have reduced the proportion of patients without etiological diagnosis, but in a significant number of patients the cause is still unknown. Our aim was to study the association of the absence of microbiological diagnosis with in-hospital. prognosis. Methods Prospective cohort of 2000 consecutive patients with IE. Data were collected in 26 Spanish hospitals. Modified Duke criteria were used to diagnose patients with suspected IE. Results A total of 290 patients (14.8%) had negative blood cultures. Etiological diagnosis was achieved with other methods (polymerase chain reaction, serology and other cultures) in 121 (6.1%). Finally, there were 175 patients (8.8%) without microbiological diagnosis (group A) and 1825 with diagnosis (group B). In-hospital mortality occurred in 58 patients in Group A (33.1%) vs . 487 (26.7%) in Group B, p = 0.07. Patients in Group A had a lower risk profile than those in Group B, with less comorbidity (Charlson index 1.9 ± 2.0 vs. 2.3 ± 2.1, p = 0.03) and lower surgical risk (EuroSCORE 23.6 ± 21.8 vs. 29.6 ± 25.2, p = 0.02). However they presented heart failure more frequently (53% vs. 40%, p = 0.005). Multivariate analysis showed that the absence of microbiological diagnosis was an independent predictor of inhospital mortality (Odds Ratio 1.8, 95% Confidence Interval 1.1–2.9, p = 0.016). Conclusion Approximately 9% of patients with IE had no microbiological diagnosis. Absence of microbiological diagnosis was an independent predictor of inhospital mortality.