Infective endocarditis: determinants of long term outcome

Abstract

Objective: To evaluate predictors of long term prognosis in infective endocarditis.

Design: Retrospective cohort study.

Setting: Tertiary care centre.

Patients: 212 consecutive patients with infective endocarditis between 1980 and 1995

Main outcome measures: Overall and cardiac mortality; event-free survival; and the following events: recurrence, need for late valve surgery, bleeding and embolic complications, cerebral dysfunction, congestive heart failure.

Results: During a mean follow up period of 89 months (range 1-244 months), 56% of patients died. In 180 hospital survivors, overall and cardiac mortality amounted to 45% and 24%, respectively. By multivariate analysis, early surgical treatment, infection by streptococci, age < 55 years, absence of congestive heart failure, and > 6 symptoms or signs of endocarditis during active infection were predictive of improved overall long term survival. Independent determinants of event-free survival were infection by streptococci and age < 55 years. Event-free survival was 17% at the end of follow up both in medically-surgically treated patients and in medically treated patients.

Conclusions: Long term survival following infective endocarditis is 50% after 10 years and is predicted by early surgical treatment, age < 55 years, lack of congestive heart failure, and the initial presence of more symptoms of endocarditis.

Figures

Figure 1

Overall survival in patients treated both medically and surgically (MST) versus those treated medically only (MT).

Figure 2

Cardiac mortality in the medically and surgically (MST) treated group versus those treated medically only (MT).

Figure 3

Overall survival of hospital survivors.

Figure 4

Overall survival in native valve endocarditis