Abstract

MODENESI, Juan C.  and  SOCIEDAD ARGENTINA DE CARDIOLOGIA. Área de Investigación y del Consejo de Cardiología Clínica et al. Predictors of In-hospital Mortality due to Infective Endocarditis in the Argentine Republic: Results of EIRA II Study. Rev. argent. cardiol. [online]. 2005, vol.73, n.4, pp.283-290. ISSN 1850-3748.

Work objective To determine the in-hospital mortality rate and the predictors of mortality of infective endocarditis (IE) in Argentina. Research Design and Methods Prospective, multicentric survey carried out in 82 hospitals all over the country (16 provinces). Patients were enrolled according to Duke criteria (definite or possible IE) during an 18-month period (June 2001-November 2002). Results Four hundred and seventy episodes in 452 patients were included (mean age 58.1±17.6 years, 69.7% male, 83% definite and 17% possible IE). Blood cultures were negative in 17.7%. The most frequent causative microorganisms were: Staphylococcus 38% (S. aureus 30%, S. coagulase-negative 8%), Streptococcus 39.4% (S. viridans 26.8%), Enterococcus 10,8%, S. coagulase-negative 8%, HACEK group 6,6% and S. bovis 5,5%. Underlying heart disease was present in 66.4% and prosthetic-valve IE was diagnosed in 19.2%. Surgical treatment was indicated in 33.3% and in-hospital mortality was 24.3%. In a logistic regression analysis the following variables were independent predictors of increased mortality: age > 65 years (OR 2.1; 95% CI 1.1-3.96; p = 0.024); heart failure (OR 5.9; 95% CI 3.1-10.9; p <0,001), septic shock (OR 25.1; 95% CI 9.9- 62.5; p <0.001), hepatic failure (OR 12.2, 95% CI 1.9-76.9; p = 0.008); persistent hyperthermia (OR 2.3, 95% CI 1.2-4; p= 0.014); altered states of consciousness and stroke showed strong predictive trends but no statistical significance. Conclusions In-hospital mortality due to IE in Argentina is high. Simple and readily available variables are strong predictors of inhospital mortality. Their use can help in identifying highrisk patients and could lead to decisions made in order to improve the outcomes of patients with IE.

Keywords : Endocarditis; Mortality; Prognosis.