Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study
Abstract
AimsThe EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE).Methodsand resultsProspective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hos-pitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnosticcriteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan,18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were col-lected.
Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), anddevice-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients.Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), entero-cocci in 390 (15.8%), andStreptococcus gallolyticusin 162 (6.6%).18F-fluorodeoxyglucose positron emission tomog-raphy/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (majorcriterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE(16.3%).
Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid orpulmonary IE, presence of a vegetation andStaphylococcus aureusIE. According to ESC guidelines, cardiac surgerywas indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them.
In-hospital deathoccurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality wereCharlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications,abscess, and failure to undertake surgery when indicated.ConclusionInfective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in itsclinical, microbiological, imaging, and therapeutic profilesKeywordsInfective endocarditis.