Diastolic blood pressure as a predictor of short-term mortality in infective endocarditis

Abstract

Background

Diastolic blood pressure (DBP) is an established risk factor for mortality in several cardiovascular diseases. However, its prognostic value in patients with infective endocarditis (IE) remains unclear.

Methods

We enrolled 1705 patients diagnosed with IE and categorized them into three groups based on admitted DBP tertiles: <60 mmHg (n = 505), 60–72 mmHg (n = 629), and ≥72 mmHg (n = 571). Restricted cubic splines were used to assess nonlinear relationships. Multivariate analysis was conducted to identify independent risk factors for adverse outcomes.

Results

Patients with DBP <60 mmHg had significantly higher rates of in-hospital mortality (10.7 % vs. 6.4 % vs. 4.4 %; P < 0.001) and major adverse clinical events (25.5 % vs. 18.0 % vs. 14.0 %; P < 0.001). An approximately inverse linear relationship was observed between DBP and in-hospital mortality. The optimal DBP cut-off value for predicting in-hospital death was 60 mmHg (AUC = 0.617; P < 0.001). DBP <60 mmHg was independently associated with in-hospital mortality (adjusted odds ratio = 2.395; P = 0.004). Kaplan–Meier analysis revealed significantly higher 6-month mortality in patients with DBP <60 mmHg compared to those with DBP ≥60 mmHg (log-rank test = 10.8; P = 0.001). Multivariate Cox analysis confirmed that DBP <60 mmHg was independently associated with 6-month mortality (adjusted hazard ratio = 1.457; P = 0.032).

Conclusions

Lower DBP was significantly associated with an increased risk of short-term mortality in IE patients. The finding highlights low DBP as an important clinical marker of disease severity that should warrant enhanced monitoring and management.