RT info:eu-repo/semantics/article
T1 Clinical profile and prognosis of patients with left-sided infective endocarditis with surgical indication who are not operated
A1 Miguel, María de
A1 López Díaz, Javier
A1 Vilacosta, Isidre
A1 Olmos, Carmen
A1 Sáez, Carmen
A1 Cabezón, Gonzalo
A1 Zulet, Pablo
A1 Jerónimo, Adrián
A1 Gómez, Daniel
A1 Pulido, Paloma
A1 Lozano, Adrián
A1 Oña, Andrea
A1 Gómez Salvador, Itziar
A1 San Román Calvar, José Alberto
K1 Endocarditis
K1 Cardiovascular system - Diseases
K1 Cardiovascular, Aparato - Enfermedades
K1 Cardiology
K1 Surgery
K1 Mortality
K1 Mortalidad
K1 Microbiology
K1 Medicine
K1 Public health
K1 3205.01 Cardiología
K1 3213 Cirugía
K1 2414 Microbiología
K1 32 Ciencias Médicas
K1 3212 Salud Publica
AB Approximately a quarter of patients with infective endocarditis (IE) who have surgical indication only receive antibiotic treatment. Their short-term prognosis is dismal. We aimed to describe the characteristics of this group of patients to evaluate the mortality according to the cause of rejection and type of surgical indication and to analyze their prognostic factors of mortality. From 2005 to 2022, 1105 patients with definite left-sided IE were consecutively attended in three tertiary hospitals. Of them, 912 (82.5%) had formal surgical indication according to the most recent European Guidelines available in each period of the study and 303 (33%) only received medical treatment. These were older, had more comorbidities and higher in-hospital (46% vs. 24%; p < 0.001) and one year mortality (57.1% vs. 27.6%; p < 0.001) than operated patients. The main reason for surgical rejection was high surgical risk (57.1%) and the highest mortality when the cause were severe neurological conditions (76%). When the endocarditis team took the decision not to operate (25.5% of the patients), in-hospital (7%) and one-year mortality (17%) were low. In-hospital mortality associated with each surgical indication was 67% in heart failure, 53% in uncontrolled infection and 45% in prevention of embolisms (p < 0.001). Heart failure (OR: 2.26 CI95%: 1.29–3.96; p = 0.005), Staphylococcus aureus (OR: 3.17; CI95%: 1.72–5.86; p < 0.001) and persistent infection (OR: 5.07 CI95%: 2.85–9.03) are the independent risk factors of in-hospital mortality. One third of the patients with left-sided IE and formal surgical indication are rejected for surgery. In-hospital mortality is very high, especially when heart failure is the indication for surgery and when severe neurological conditions the reason for rejection. Short term prognosis of patients rejected by a specialized endocarditis team is favorable.
PB MDPI
SN 2076-2607
YR 2024
FD 2024
LK https://uvadoc.uva.es/handle/10324/70198
UL https://uvadoc.uva.es/handle/10324/70198
LA eng
NO Microorganisms, 2024, Vol. 12, Nº. 3, 607
NO Producción Científica
DS UVaDOC
RD 06-oct-2024