Clinical Profile and Predictors of Poor Prognosis in Infective Endocarditis

Abstract

ABSTRACT Context: Infective endocarditis (IE) is associated with high morbidity and mortality despite advances in diagnosis and treatment. A recent knowledge of the epidemiology and clinical spectrum of IE is essential for prompt recognition and effective therapy. Aims: This study aims to determine the clinical profile, and outcome of patients with IE and to identify the clinical and laboratory predictors of poor prognosis in patients with IE. Settings and Design: This is a prospective observational study among patients diagnosed with IE in a tertiary care center over a period of 12 months. Subjects and Methods: We collected the demographic, clinical, and laboratory evaluation details of consecutive patients admitted with IE. All the patients were followed during hospitalization for mortality, complications, and need for surgery. Statistical Analysis Used: The comparison of mean values across the different outcome groups was done using one-way analysis of variance test. The association between the categorical independent variables with the outcome was evaluated using the Pearson Chi-square test. Results: Among 75 patients admitted with IE rheumatic heart disease was the most common predisposing condition. Blood culture was positive in 80%. Staphylococcus aureus was the most common organism. Total in-hospital mortality was 32%. Staphylococcal IE had 43% mortality and fungal IE had 57% mortality. Prosthetic valve endocarditis also had 57% mortality. Surgery was undertaken in 28% of patients and surgical mortality was 19%. Presence of heart failure, thrombocytopenia, leukocytosis, elevated neutrophil-to-lymphocyte ratio, elevated platelet-to-lymphocyte ratio, high serum creatinine, and C-reactive protein were associated with high mortality. Conclusions: The mortality associated with IE remains high. Clinical and laboratory parameters can reliably predict poor prognosis in IE.