Characteristics, risk factors and outcomes of patients managed for left-sided infective endocarditis: A prospective study in a high-volume center.

Available prospective data on infective endocarditis (IE) remain scarce, although further knowledge on this serious condition could help improving the prognosis of patients. To describe the characteristics and outcomes of left-sided IE and to determine the risk factors associated to in-hospital mortality in a high-volume center. From 15 September 2020 to 15 February 2023, all patients with left-sided IE managed in a tertiary center of cardiology were included in this prospective, observational study. Diagnosis of IE was made according to current guidelines and management was collegially discussed by the endocarditis team. Determinants of in-hospital death were assessed using a multivariate logistic regression model including any covariate associated in univariate analysis (P < 0.1). A total of 185 patients were included during the study period. Median age was 68 [56–76] years, 141 (76%) patients were males, and 75 (41%) cases involved a prosthetic valve. Aortic valve, mitral valve and involvement of both valves were observed in 111 (60%), 48 (26%) and 26 (14%) patients, respectively. Severe valvular regurgitation was identified in 56 (30%) patients, root abscess and/or false aneurysms in 57 (31%) patients. A pathogen agent was identified in 169 (91%) patients, and the most frequent germs were Staphylococcus (30%), Streptococcus (30%) and Enterococcus (17%). A severe initial presentation requiring intensive care unit (ICU) admission was observed in 42 (23%) patients. Cardiac surgery was performed in 102 (55%) cases, and 41 (22%) patients required an emergent surgery. A total of 37 (20%) patients died during the initial in-hospital phase, mostly from cardiac or neurovascular causes. In a multivariate analysis, hypertension (odds ratio [OR] = 3.3; 95% confidence interval [CI]: 1.4–10), bi-valvular endocarditis (OR = 3.1; 95%CI: 1.0–9.5), unidentified pathogen (OR = 4.3; 95%CI: 1.7–15) and chronic alcoholic abuse (OR = 16.4; 95%CI: 3.7–87.9) were independently associated with increased in-hospital mortality (Table 1). In this cohort, the patients have a severe initial status frequently requiring an ICU admission and/or urgent cardiac surgery. Chronic alcoholic abuse appears as a major determinant of mortality. IE remains a severe condition which should be managed by experienced teams. [ABSTRACT FROM AUTHOR]