Infective endocarditis at a tertiary care hospital in South Korea

ObjectiveThe treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.MethodsA 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.ResultsWe included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused by Staphylococcus aureus (OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, p<0.001) and was associated with improved long-term prognosis compared with medical treatment only (p<0.001).ConclusionsThe incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE.

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146. Infective Endocarditis in South Korea: a 12-year Single-Center Experience of 419 Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.221 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S100-S101

Author(s):

Jung Ho Kim ◽

Hi Jae Lee ◽

Woon Ji Lee ◽

Hye Seong ◽

Jin young Ahn ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Logistic Regression ◽

Regression Analysis ◽

Infective Endocarditis ◽

Mortality Rate ◽

South Korea ◽

Hospital Mortality ◽

Incidence Rate ◽

Logistic Regression Analysis

Abstract Background Infective endocarditis (IE) is a potentially lethal disease that has undergone constant changes in epidemiology and pathogen. Treatment of IE has become more complex with today’s myriad healthcare-associated factors as well as regional differences in causative organisms. Therefore, it is necessary to investigate the overall trends, microbiological features, clinical characteristics and outcomes of IE in South Korea. Methods We performed a retrospective cohort study of patients with the diagnosis of probable or definite IE according to the modified Duke Criteria admitted to a tertiary care center in South Korea between November 2005 and August 2017. Poisson log-linear regression was used to estimate time trends of IE incidence rate and mortality rate. Risk factors for in-hospital mortality were evaluated by multivariate logistic regression analysis including an interaction term. Results There were 419 IE patients (275 male vs. 144 female) during the study period. The median age of the patients was 56 years. The annual incidence rate of IE of our institution was significantly increased. (RR 1.05; 95% CI, 1.02–1.08; P = 0.006) The mortality rate showed trends toward down, but not statistically significant (P = 0.875). IE was related to a prosthetic valve in 15.0% and 21.7% patients developed IE during hospitalization. The mitral valve was the most commonly affected valve (61.3%). Causative microorganisms were identified in 309 patients (73.7%) and included streptococci (34.6%), followed by Staphylococcus aureus (15.8%) and enterococci (7.9%). The in-hospital mortality rate was 14.6%. Logistic regression analysis found aortic valve endocarditis (OR 3.18; P = 0.001), IE caused by staphylococcus aureus (OR 2.32; P = 0.026), a presence of central nervous system embolic complication (OR 1.98; P = 0.031), a high SOFA score (OR 1.22; P = 0.023) and a high Charlson’s comorbidity index (OR 1.11; P = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be a protective factor against mortality. (OR 0.25, P < 0.001) Conclusion Although IE has been increasing, the mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis. Disclosures All authors: No reported disclosures.

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Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

10.21203/rs.2.19349/v1 ◽

2019 ◽

Author(s):

Zhenzhu Wu ◽

Yi Chen ◽

Tingting Xiao ◽

Tianshui Niu ◽

Qingyis Shi ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Infective Endocarditis ◽

Mortality Rate ◽

Hospital Mortality ◽

Tertiary Hospital ◽

The Past ◽

Increasing Trend ◽

One Year

Abstract Background: To explore the trends in epidemiology and risk factors related to the prognosis of infective endocarditis in a teaching hospital over the past ten years. Methods: A retrospective cohort study was performed. A total of 407 consecutive patients were included. The clinical characteristics and risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 12.2%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease which showed a decreased trend during this period (P<0.001). There were 222(54.5%) positive blood cultures and streptococci (44.1%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 234 patients (57.5%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.5, 95% CI 5.5-148.1) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. Conclusions: There was no significant change in the overall incidence of IE, the clinical features of IE have changed slightly during the past ten years. Streptococci IE was still the predominant. IE patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.

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Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

10.21203/rs.3.rs-16299/v4 ◽

2020 ◽

Author(s):

Zhenzhu Wu ◽

Yi Chen ◽

Tingting Xiao ◽

Tianshui Niu ◽

Qingyi Shi ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Infective Endocarditis ◽

Mortality Rate ◽

Hospital Mortality ◽

Tertiary Hospital ◽

The Past ◽

Increasing Trend ◽

One Year

Abstract Background: To explore the trends in epidemiology and the risk factors related to the prognosis of infective endocarditis in a tertiary hospital over the past ten years. Methods: A retrospective cohort study was performed. A total of 407 consecutive patients who were admitted with infective endocarditis were included. The clinical characteristics and the risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 11.3%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease(17.0%) which showed a decreased trend during this period (P<0.001). There were 222(54.5%) patients with positive blood cultures results and Streptococci (24.6%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 235 patients (57.7%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.594, 95% CI 5.561-148.173) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. Conclusions: There were no significant change in the overall incidence of infective endocarditis, but the clinical features of infective endocarditis had slightly changed during the past ten years. Streptococci infective endocarditis was still the predominant. Patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome. Keywords: Infective endocarditis, epidemiology, risk factors, mortality.

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Surgical treatment of valve endocarditis in high-risk patients and predictors of long-term outcomes

Scientific Reports ◽

10.1038/s41598-021-03602-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Giuseppe Nasso ◽

Giuseppe Santarpino ◽

Marco Moscarelli ◽

Ignazio Condello ◽

Angelo Maria Dell’Aquila ◽

...

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

High Risk ◽

Aortic Valve ◽

Hospital Mortality ◽

Long Term Outcomes ◽

High Risk Patients ◽

Risk Patients

AbstractInfective endocarditis represents a surgical challenge associated with perioperative mortality. The aim of this study is to evaluate the predictors of operative mortality and long-term outcomes in high-risk patients. We retrospectively analyzed 123 patients operated on for infective endocarditis from January 2011 to December 2020. Logistic regression model was used to identify prognostic factors of in-hospital mortality. Long term follow-up was made to asses late prognosis. Preoperative renal failure, an elevation EuroSCORE II and prior aortic valve re-replacement were found to be preoperative risk factors significantly associated with mortality. In-hospital mortality was 27% in patients who had previously undergone aortic valve replacement (n = 4 out of 15 operated, p = 0.01). Patients who were operated on during the active phase of infective endocarditis showed a higher mortality rate than those operated on after the acute phase (16% vs. 0%; p = 0.02). The type of prosthesis used (biological or mechanical) was not associated with mortality, whereas cross-clamp time significantly correlated with mortality (mean cross-clamp time 135 ± 65 min in dead patients vs. 76 ± 32 min in surviving patients; p = 0.0005). Mean follow up was 57.94 ± 30.9 months. Twelve patients died (11.65%). Among the twelve mortalities, five were adjudicated to cardiac causes and seven were non-cardiac (two cancers, one traumatic accident, one cerebral hemorrhage, two bronchopneumonia, one peritonitis). Overall survival probability (freedom from death, all causes) at 3, 5, 7 and 8 years was 98.9% (95% CI 97–100%), 96% (95% CI 92–100%), 85.9% (95% CI 76–97%), and 74% (95% CI 60–91%) respectively. Our study demonstrates that an early surgical approach may represent a valuable treatment option for high-risk patients with infective endocarditis, also in case of prosthetic valve endocarditis. Although several risk factors are associated with higher mortality, no patient subset is inoperable. These findings can be helpful to inform decision-making in heart team discussion.

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Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

10.21203/rs.3.rs-16299/v2 ◽

2020 ◽

Author(s):

Zhenzhu Wu ◽

Yi Chen ◽

Tingting Xiao ◽

Tianshui Niu ◽

Qingyi Shi ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Infective Endocarditis ◽

Mortality Rate ◽

Hospital Mortality ◽

Tertiary Hospital ◽

The Past ◽

Increasing Trend ◽

One Year

Abstract Background: To explore the trends in epidemiology and risk factors related to the prognosis of infective endocarditis in a teaching hospital over the past ten years.Methods: A retrospective cohort study was performed. A total of 407 consecutive patients were included. The clinical characteristics and risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 12.2%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease which showed a decreased trend during this period (P<0.001). There were 222(54.5%) positive blood cultures and Streptococci (24.1%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 234 patients (57.5%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.594, 95% CI 5.561-148.173) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality.Conclusions: There was no significant change in the overall incidence of infective endocarditis, the clinical features of infective endocarditis have changed slightly during the past ten years. Streptococci infective endocarditis was still the predominant. Infective endocarditis patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.

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Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

10.21203/rs.3.rs-16299/v1 ◽

2020 ◽

Author(s):

Zhenzhu Wu ◽

Yi Chen ◽

Tingting Xiao ◽

Tianshui Niu ◽

Qingyi Shi ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Infective Endocarditis ◽

Mortality Rate ◽

Hospital Mortality ◽

Tertiary Hospital ◽

The Past ◽

Increasing Trend ◽

One Year

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Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

10.21203/rs.3.rs-16299/v3 ◽

2020 ◽

Author(s):

Zhenzhu Wu ◽

Yi Chen ◽

Tingting Xiao ◽

Tianshui Niu ◽

Qingyi Shi ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Infective Endocarditis ◽

Mortality Rate ◽

Hospital Mortality ◽

Tertiary Hospital ◽

The Past ◽

Increasing Trend ◽

One Year

Abstract Background: To explore the trends in epidemiology and the risk factors related to the prognosis of infective endocarditis in a tertiary hospital over the past ten years.Methods: A retrospective cohort study was performed. A total of 407 consecutive patients who were admitted with infective endocarditis were included. The clinical characteristics and the risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 11.3%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease(17.0%) which showed a decreased trend during this period (P<0.001). There were 222(54.5%) patients with positive blood cultures results and Streptococci (24.6%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 235 patients (57.7%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.594, 95% CI 5.561-148.173) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality.Conclusions: There were no significant changes in the overall incidence of infective endocarditis, but the clinical features of infective endocarditis had slightly changed during the past ten years. Streptococci infective endocarditis was still the predominant. Patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.

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Higher programmatic volume in paediatric heart surgery is associated with better early outcomes

Cardiology in the Young ◽

10.1017/s1047951115002073 ◽

2015 ◽

Vol 25 (8) ◽

pp. 1572-1578 ◽

Cited By ~ 6

Author(s):

Andrzej Kansy ◽

Tjark Ebels ◽

Christian Schreiber ◽

Jeffrey P. Jacobs ◽

Zdzislaw Tobota ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Hospital Mortality ◽

Heart Surgery ◽

Major Complication ◽

High Volume ◽

Patient Specific ◽

Hospital Death ◽

Data Set ◽

Multivariable Logistic Regression

AbstractObjectivePrevious analyses have suggested an association between centre volume and in-hospital mortality, post-operative complications, and mortality in those patients who suffer from a complication. We sought to determine the nature of this association using a multicentre cohort.MethodsAll the patients, aged 18 years or younger, undergoing heart surgery at centres participating in the European Congenital Heart Surgeons Database (2003–2013) were included. Programmes were grouped as follows: small <150; medium 150–250; large 251–349; very large >350. Multivariable logistic regression was used to identify the differences between groups with the adjusted in-hospital mortality, onset of any and/or major complication, and in-hospital mortality in those patients with any and/or major complication. The outcomes were adjusted for patient specific risk factors and surgical risk factors.ResultsThe data set consisted of 119,345 procedures performed in 99 centres. Overall, in-hospital mortality was 4.63%; complications occurred in 23.4% of the patients. In-hospital mortality in patients with complications was 13.82%. Multivariable logistic regression showed that the risk of in-hospital death was higher in low- and medium-volume centres (p<0.001). The rate of the occurrence of any post-operative complication in small, medium, and large programmes was lower compared with very large centres (p<0.001). Low- and medium-volume centres were associated with significantly higher mortality in patients with any complication (p<0.001).ConclusionsOur analysis showed that the risk of in-hospital mortality was lower in higher-volume centres. Although the risk of complications is higher in high-volume centres, the mortality associated with complications that occurred in these centres was lower.

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Association between surgical treatment and in-hospital mortality in patients with infective endocarditis stratified by NYHA classification: a nationwide retrospective study in Japan

European Heart Journal ◽

10.1093/ehjci/ehaa946.2688 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Kiriyama ◽

H Kaneko ◽

T Kamon ◽

H Itoh ◽

T Jo ◽

...

Keyword(s):

Logistic Regression ◽

Surgical Treatment ◽

Infective Endocarditis ◽

Hospital Mortality ◽

Surgical Intervention ◽

Nyha Class ◽

Multivariable Logistic Regression Analysis ◽

Multivariable Logistic Regression Model ◽

Multivariable Logistic Regression ◽

Nyha Classification

Abstract Background Heart failure (HF) is one of the major complications of infective endocarditis (IE). The ESC guideline described that surgical treatment should be performed for the patients with IE complicated with HF. However, decision making of surgical indication in real-world clinical setting is not easy for patients with IE concomitant with HF due to complicated conditions, and the clinical benefit of surgical intervention for IE and HF is unclear. Purpose We sought to uncover the association between surgical treatment and in-hospital mortality among the patients admitted for community-acquired IE respectively according to the severity of HF symptoms (NYHA class I to IV). Methods We studied 3,403 patients diagnosed as IE (mean age 65.9 years, 61.6% males) with records of baseline NYHA classification (I to IV) who survived for more than 2 days, using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. Patients were classified into four groups: 919 patients (27.0%) in NYHA I, 1,007 patients (29.6%) in NYHA II, 767 patients (22.5%) in NYHA III, and 710 patients (20.9%) in NYHA IV. A multivariable logistic regression model adjusted for age, gender, Barthel Index, Charlson Comorbidity Index, and usage of inotropic therapy at admission was performed to evaluate the association between the surgical treatment and in-hospital mortality. Results Patients with higher NYHA classification were significantly older and were more likely to be female than those with lower NYHA classification. At admission, patients with higher NYHA classification had lower baseline activities and higher comorbidities, and also had more complications including stroke, shock and disseminated intravascular coagulation than those with lower NYHA classification. In-hospital mortality was seen in 406 patients (11.9%) in the entire cohort. The mortality rate significantly increased with the NYHA class (NYHA I, 3.6%; NYHA II, 8.4%; NYHA III, 11.9%; NYHA IV, 27.9%: p<0.001). According to the multivariable logistic regression analysis, surgical treatment was independently associated with lower in-hospital mortality (Odds ratio 0.395, 95% Confidence Interval 0.297–0.526; p<0.001). A fragmentated analysis in each NYHA classification showed that the survival benefit of surgical intervention was pronounced in patients with higher NYHA class (Figure). The limitation of our study was including the potential unmeasured confounders, which lead to overestimate the relationship between the surgical treatment and in-hospital mortality even after excluding the critically ill patients who died within 2 days and adjusting for the measured confounders. Conclusion Surgical treatment was associated with lower in-hospital mortality among the patients with IE complicated with HF, particularly among those with more advanced HF status. Our study implies that surgical treatment might be beneficial for the patients with advanced HF. Funding Acknowledgement Type of funding source: None

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399. Risk Factors for Mortality in COVID-19 Patients in a Community Teaching Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.594 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S268-S268

Author(s):

Justin A Andrade ◽

Karina Muzykovsky ◽

James Truong

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Logistic Regression ◽

Hospital Mortality ◽

Teaching Hospital ◽

Case Series ◽

Advanced Age ◽

Retrospective Case ◽

Multivariable Logistic Regression ◽

Community Teaching

Abstract Background As of May 2020, there were over 190,000 confirmed COVID-19 cases in New York City (NYC) with approximately 13,000 deaths. Previously published literature identified risk factors (advanced age, higher severity of illness and elevated d-dimer) for mortality in a cohort of patients from Wuhan, China and mechanical ventilation in a case series from NYC. Another case series from NYC evaluated clinical outcomes only. There are limited published studies assessing clinical characteristics, outcomes and risk factors for mortality in COVID-19 patients in NYC. The objective of this study was to assess the risk factors for mortality in patients with confirmed COVID-19 infections. Methods This study was a single center retrospective case-control at The Brooklyn Hospital Center, a 464-bed community teaching hospital. Adult patients with confirmed COVID-19 infection, who received at least 24 hours of COVID-19 therapy were included. Endpoints assessed were risk factors for mortality in COVID-19 patients, increase in QTc, renal failure or renal replacement therapy, ventricular fibrillation or ventricular tachycardia. Baseline characteristics between survivor and non-survivors were analyzed utilizing Mann-Whitney U test/two-tailed t-tests for continuous data and Chi-square/Fisher’s exact test for categorical data. Univariable and multivariable logistic regression analyses were conducted to identify the risk factors for in-hospital mortality. Results Two-hundred and eighty six patients were included in this analysis, of whom 97 (33.9%) were non-survivors and 189 (66.1%) patients were survivors. Diabetes and coronary artery disease were more common in non-survivors compared to survivors (p = 0.003 and p < 0.001, respectively). Multivariable logistic regression showed higher in-hospital mortality in patients with advanced age (odds ratio 5.779, 95 % confidence interval 1.369–24.407), vasopressor initiation (OR 28.301, 95 % CI 3.307–242.176), and development of renal failure (OR 30.927, 95 % CI 1.871–511.201). Conclusion Risk factors associated with mortality for COVID-19 patients in a community teaching hospital include advanced age, vasopressor therapy, and development of renal failure. Disclosures All Authors: No reported disclosures

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