ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2022 August;63(4):507-13

DOI: 10.23736/S0021-9509.22.12092-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Risk factors associated with mortality in the infective endocarditis patients requiring cardiac surgery: a study based on Latvian population

Kristians MEIDROPS ^{1, 2} ✉, Janis D. OSIPOVS ¹, Arina ZURAVLOVA ¹, Valerija GROMA ¹, Martins KALEJS ^{1, 2}, Eva PETROSINA ^{3, 4}, Roberts LEIBUSS ^{1, 5}, Eva STRIKE ^{1, 5}, Uga DUMPIS ⁶, Andrejs ERGLIS ^{7, 8}, Peteris STRADINS ^{1, 2}

¹ Riga Stradins University, Riga, Latvia; ² Center of Cardiac Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia; ³ Unit of Statistics, Riga Stradins University, Riga, Latvia; ⁴ UL House of Science, Faculty of Physics, Mathematics and Optometry, University of Latvia, Riga, Latvia; ⁵ Department of Cardiovascular Anaesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, Latvia; ⁶ Department of Infection Control, Pauls Stradins Clinical University Hospital, Riga, Latvia; ⁷ Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia; ⁸ UL House of Science, Faculty of Medicine, University of Latvia, Riga, Latvia

BACKGROUND: Increased life expectancy, developments in medicine and intracardiac devices, accessibility of cardiac surgery, decrease in the prevalence of rheumatic heart disease are changing infective endocarditis patient profile and thus risk factors for the adverse events. This single-center-based study covering the whole Latvian population aimed to assess the intrahospital and 3-year mortality of infective endocarditis patients who underwent cardiac surgery, as well as risk factors and laboratory indices predictive of adverse outcomes of the disease.
METHODS: Clinical profiles, data of laboratory and instrumental analyses, operation and intensive care unit records of cardiac surgery patients treated in Pauls Stradins Clinical University Hospital, Riga, Latvia, between 2015 and 2019 were analyzed.
RESULTS: We analyzed data from 242 episodes of surgically treated infective endocarditis in 233 patients. The median age of patients was 57.00 (45.00-68.00) years. The rate of intrahospital mortality was 11.16%. Risk factors associated with mortality in the univariate analyses were S. aureus infection (HR=2.27, 95% CI: 1.36-3.80; P=0.002) and systemic embolization of vegetations (HR=1.63, 95% CI: 1.00-2.64; P=0.048). Perivalvular complications (HR=1.98, 95% CI: 1.19-3.29; P=0.009) were found to be independently associated with mortality in multivariate analysis (HR=1.99, 95% CI: 1.05-3.78; P=0.035). One-year survival was 78.3%, whereas three-year -71.3%.
CONCLUSIONS: Intrahospital mortality of surgically treated IE patients was 11.2%; however, one- and three-year mortality was 21.7 and 28.7%, respectively. Perivalvular complications were independently associated with mortality. Laboratory indices were not predictive of adverse outcomes.

KEY WORDS: Endocarditis; Risk factors; Complications