Multivariate and survival analysis of prognosis and surgical benefits in infective endocarditis.

Abstract

Background. Antibiotic therapy is the primary treatment for infective endocarditis (IE), yet up to 50% of patients still require surgical intervention. However, surgical intervention carries significant risks of mortality and complications for IE patients, and there remains a lack of consensus on which preoperative characteristics of infective endocarditis have a substantial impact on patient prognosis. Particularly, some IE patients develop periannular abscesses, leading to more severe complications. Objectives. The objective of our study is to identify predictors of poor outcomes in infective endocarditis and to further evaluate the impact of surgical intervention on patient prognosis, with the aim of adding value to the existing factors known to affect IE prognosis. Methods. In this retrospective cohort study, we evaluated 210 patients treated for infective endocarditis (IE) at our hospital between December 2016 and June 2023. To analyze short-term outcomes, the patients were divided into two groups based on whether they experienced poor outcomes. We compared demographic characteristics, echocardiographic findings, laboratory test results, surgical details, and postoperative outcomes between the two groups. Patients' long-term outcomes, including survival status and time of death, were assessed through follow-up, which involved telephone contact with the patient or their family. The follow-up period concluded on June 30, 2024. Results. The median age of the patients was 55 years, with most patients ranging from 42 to 64 years. Male patients accounted for 67.1%, and 21.4% had underlying cardiac conditions. During hospitalization, 125 out of 210 patients (59.5%) underwent surgery, with an emergency surgery rate of 6.2% and an in-hospital mortality rate of 13.8%.Regarding short-term outcomes, multivariate logistic regression analysis indicated that surgical treatment (OR 0.211, 95% CI 0.073-0.621) was associated with better patient prognosis. Periannular abscess (OR 4.948, 95% CI 1.005-24.349) and poorer cardiac function (NYHA II [OR 0.041, 95% CI 0.008-0.224], NYHA III [HR 0.207, 95% CI 0.057-0.757], with NYHA IV as the reference group) were significantly associated with poor prognosis in IE patients. For long-term outcomes, multivariate Cox survival analysis showed that surgical treatment (HR 0.200, 95% CI 0.091-0.437) was associated with improved long-term survival. Cerebral infarction (HR 1.939, 95% CI 1.050-3.582) and poorer cardiac function (NYHA II [HR 0.108, 95% CI 0.037-0.313], NYHA III [HR 0.308, 95% CI 0.118-0.805], with NYHA IV as the reference group) were significant factors associated with long-term mortality in IE patients. Conclusions. Surgical treatment was associated with improved short-term prognosis and long-term survival rates in patients with infective endocarditis. In terms of short-term outcomes, the presence of periannular abscesses and poor cardiac function were significant factors associated with poor prognosis. For long-term outcomes, cerebral infarction and poor cardiac function were significant factors associated with increased long-term mortality in these patients.