PURPOSE: Infective endocarditis (IE) carries high mortality and morbidity but little is known about factors affecting long term mortality and survival in younger IE patients, who may be more amenable to surgical treatment. We conducted a study looking for epidemiologic and clinical factors affecting long term outcome of IE in young adults.
METHODS: Consecutive patients admitted to tertiary hospital for definite and possible IE, as defined by the modified Dukes criteria, between February, 1997, through October, 2008 were retrospectively reviewed. Patients who had prosthetic valve or age >50 were excluded from the study. Survival was analyzed using Cox proportional hazard model and Kaplan-Meier method.
RESULTS: 116 patients are included in the analysis. 76 patients received medical treatment and 40 patients received surgical treatment. Mortality was 0.09 per year. In univariate analysis, male sex (HR 1.82, CI 1.0-3.3, p=0.04), renal failure (HR 2.15, CI 1.12-4.11, p=0.02), and positive blood culture (HR 2.03, CI 0.95-4.35, p=0.06) were associated with increased mortality. White race (HR 0.41, CI 0.22-0.77, p=0.005), surgical treatment (HR 0.51, CI 0.26-1.00, p=0.05) and MSSA endocarditis (HR 0.39, CI 0.14-1.08, p=0.06) were associated with improved survival. Although surgical patients had significantly high rate of heart failure, valve perforation, severe valvular regurgitation and cardiac absecess, surgical treatment was the only variable that was statistically significantly associated with improved survival (HR 0.49, CI 0.24-0.98, p=0.04) in multivariate analysis.
CONCLUSIONS: Surgical treatment of endocarditis is associated with improved survival compared to medical management.
CLINICAL IMPLICATIONS: Early surgical intervention with endocarditis should be done unless limited by specific clinical concerns.
DISCLOSURE: The following authors have nothing to disclose: Jeong Yun, Athanasios Smyrlis, Young Chae, Jonathan Sarik, Aman Amanullah, Benjamin Youdelman
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