Predictors of In-Hospital Mortality in Infective Endocarditis: A Retrospective Cohort Analysis

Predictors of In-Hospital Mortality in Infective Endocarditis

Abstract

Background: Infective endocarditis (IE) remains a disease of high morbidity and mortality. The epidemiological profile has shifted, with fewer rheumatic cases but more healthcare-associated and prosthetic valve infections. Management remains complex, particularly regarding the role of antithrombotic therapies. We evaluated clinical features, microbiology, and predictors of in-hospital mortality among adult IE patients, focusing on anti-platelet therapy.

Materials and Methods We retrospectively reviewed 122 adult patients diagnosed with definite or possible IE at a tertiary University Hospital between 2000-2013 according to modified Duke criteria. Data on demographics, comorbidities, predisposing factors, clinical presentation, laboratory and echocardiographic findings, microbiology, antithrombotic use, surgical management, and outcomes were extracted. Univariable and multivariable analyses were performed to identify predictors of in-hospital mortality. Results: Results: The mean age was 52.5 ± 14.2 years; 63.1% were male. Rheumatic fever was present in 35.2%, prosthetic valves in 34.4%, and intracardiac devices in 7.4%. The most frequent pathogen was Staphylococcus aureus (25.5%), followed by streptococci (16.3%). Culture-negative endocarditis accounted for 33.3% of cases. The overall in-hospital mortality was 26.2%. Non-survivors were significantly older (57.4 vs. 50.8 years) and had shorter duration of symptoms before admission (<15 days). Multivariable regression showed worsening echocardiographic findings (OR 5.44, p=0.026) and pre-existing antiplatelet therapy (aspirin OR 2.64, p=0.021; other antiplatelets OR 3.95, p=0.015) as the strongest independent predictors of death. Conclusions: This study highlights shifting epidemiology in Turkey with increasing age, prosthetic/device-associated cases, and a rising burden of S. aureus. Antiplatelet use was independently associated with increased mortality.