Temporal evolution and prognostic factors of early prosthetic endocarditis over the last 27 years
P Landin, D Gomez Ramirez, C Olmos, J Lopez, C Saez Bejar, M de Miguel, J Perez Serrano, A Lozano, I Vilacosta, J A San RomanAbstract
Background
The aim of the study was to analyse the temporal trends in early prosthetic infective endocarditis (IE) over the last 27 years and to evaluate the main associated prognostic factors.
Methods
Prospective cohort of a total of 1,745 patients with left-sided IE in three tertiary hospitals between 1998 and 2024. Of the total, patients with prosthetic IE (n=711) were selected, of whom 32.2% (n=229) presented early. Temporal trends in the epidemiological, clinical, microbiological, and prognostic profiles were evaluated, and a univariate analysis was performed to identify predictors of in-hospital mortality.
Results
During the study period, there were no significant changes in the proportion of early prosthetic IE out of the total number of prosthetic IE, with percentages remaining between 27% and 35% (p=0.184).
During this time, the age of patients increased significantly. In addition, there was an increase in patients referred from other hospitals and a higher prevalence of comorbidities such as cancer and anaemia. There were no significant changes in the frequency of the main microorganisms, but there was an increase in the presence of vegetations and severe valve regurgitation. There were also no significant changes in the percentage of periannular complications, in-hospital complications, or rates of cardiac surgery or in-hospital mortality (Table).
Comorbidities such as COPD and Staphylococcus aureus infections were identified as risk factors for higher in-hospital mortality. Periannular complications, the presence of vegetations, and in-hospital complications were also associated with higher mortality, as were higher surgical risk scores and failure to perform indicated cardiac surgery. Cardiac surgery was a protective factor (Figure).
Conclusions
The percentage of patients with early prosthetic IE has remained stable over the last 27 years. Despite the epidemiological changes described in recent decades in the overall IE patient population, most of the epidemiological, clinical, microbiological, and prognostic characteristics of patients with early prosthetic IE have not changed significantly.Figure Univariate analysesTable temporal trends