Clinical spectrum, presentation, and risk factors for mortality in infective endocarditis: a review of 68 cases at a tertiary care center in Turkey [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2009; 37(1): 9-18

Clinical spectrum, presentation, and risk factors for mortality in infective endocarditis: a review of 68 cases at a tertiary care center in Turkey

Aylin Tuğcu1, Özlem Yıldırımtürk1, Corç Baytaroğlu1, Hilal Kurtoğlu2, Özkan Köse2, Murat Şener2, Saide Aytekin2
1Department of Cardiology, Florence Nightingale Hospital, İstanbul
2Department of Cardiology, İstanbul Bilim University, Florence Nightingale Hospital, İstanbul


OBJECTIVES
This study was designed to evaluate clinical, laboratory, microbiological, and echocardiographic characteristics of infective endocarditis (IE) at a tertiary care center in Turkey and to identify predictors of in-hospital mortality.

STUDY DESIGN
Based on a systematic retrospective review of clinical records covering 1997 to 2007, we analyzed data and outcomes of 68 patients (40 males, 28 females; mean age 51±20 years) with definite or possible IE according to the modified Duke criteria.

RESULTS
Native valve endocarditis (NVE) was seen in 28 patients (41.2%), and prosthetic valve endocarditis (PVE) was seen in 38 patients (55.9%). Pacemaker endocarditis (PE) was observed in only two patients (2.9%). Nineteen patients (27.9%) had nosocomial IE. The most frequent predisposing factor for NVE was rheumatic heart disease (n=11; 39.3%). Echocardiography failed to show any signs of involvement in five patients (13.2%) with PVE. The most common causative microorganisms of NVE, PVE, and PE were staphylococci (n=28; 41.2%). At least one complication developed in 46 patients (67.7%), congestive heart failure being the most common (n=38; 55.9%). Forty-one patients (60.3%) underwent combined medical and surgical treatment. In-hospital mortality occurred in 17 patients (25%). Mortality rates were 37.5%, 30%, and 14.3% for early and late PVE and NVE, respectively. Mortality was significantly higher with nosocomial IE (57.9%) compared to 12.2% in the remaining patients. In multivariate analysis, septic shock (p=0.011) and nosocomial infection (p=0.032) were independently associated with in-hospital mortality.

CONCLUSION
Compared to the European series, IE in our cohort occurred in a relatively younger population, with rheumatic heart disease as the most common underlying heart disease. The rates of PVE, nosocomial IE, and surgical treatment were about the same.

Keywords: Cross infection, endocarditis, bacterial/therapy/mortality, heart valve prosthesis; hospital mortality; prognosis.

How to cite this article
Aylin Tuğcu, Özlem Yıldırımtürk, Corç Baytaroğlu, Hilal Kurtoğlu, Özkan Köse, Murat Şener, Saide Aytekin. Clinical spectrum, presentation, and risk factors for mortality in infective endocarditis: a review of 68 cases at a tertiary care center in Turkey. Turk Kardiyol Dern Ars. 2009; 37(1): 9-18

Corresponding Author: Saide Aytekin, Türkiye
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