Characteristics and determinants of mortality of patients hospitalized for left-sided infective endocarditis in a tertiary center: data from the prospective EIPSL cohort

Abstract Introduction Infective endocarditis (IE) is associated with high morbidity and mortality. Available prospective data are scarce, further knowledge from prospective cohorts could help optimize the prognostic of patients with IE. Purpose To describe the characteristics and determinants of in-hospital mortality of left-sided IE in a high-volume center. Methods From September 15, 2020 to April 30, 2024, all hospitalized patients for left-sided IE in a tertiary center were prospectively included. Determinants of in-hospital mortality of prosthetic valve IE (PVE) and native valve IE (NVE) subgroups were assessed separately, using a multivariate logistic regression model including any covariate associated in univariate analysis (p 0.1). Results A total of 317 patients were included, 141 (44%) with PVE and 176 (56%) with NVE. The median age was 68 58-76 years and 77% of patients were men. Initial admission to intensive care unit (ICU) was required for 70 (25%) patients. The microorganism was identified in 292 (92%) cases, and Staphylococcus, Streptococcus or Enterococcus were the most documented germs (82%). In PVE, a 18F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) was performed in 43 (31%) patients and a cardiac CT scanner in 63 (45%) patients. A cardiac abscess was identified in 24% of patients. Cardiac surgery was performed in 172 (54%) patients, and 68/172 (40%) patients required emergent surgery. Compared to PVE, patients with NVE were younger and Staphylococcus aureus was more frequently involved, but the number of abscess and surgery rate were similar. Overall, in-hospital death occurred in 64 (20%) patients. In the PVE group, predictors of in-hospital mortality (24/141, 17%) were age (OR=1.07; 95%CI: 1.02–1.13), cardiac abscess (OR=1.07; 95%CI: 1.02–1.13) and severe valvular leak (OR=3.4; 95CI: 1.03–11.3). In the NVE group, factors associated with in-hospital mortality were age (OR=1.05; 95CI: 1.01–1.09), HIV infection (OR=22.5; 95CI: 1.4–374.6), chronic alcoholic abuse (OR=4.1; 95CI: 1.2–13.5) and initial ICU admission (OR=3.7; 95CI: 1.4–9.7). Conclusion In this cohort, patients had frequent severe initial presentation and multiple comorbidities with high in-hospital mortality. Determinants of mortality appear to differ between PVE and NVE.