A Retrospective Analysis Of Clinical Features And Prognosis Of Infective Endocarditis Over Ten Years

Objectives:To explore the clinical characteristics and prognostic factors of patients with infective endocarditis(IE)in our hospital over the past ten years,and provide information for clinical diagnosis and treatment of IE.Methods:A retrospective analysis of clinical data from patients admitted to the First Affiliated Hospital of Zhejiang University School of Medicine and diagnosed as IE from January 1,2007 to December 31,2016 was conducted.Four major parts of the clinical characteristics of patients with IE in the past decades and the risk factors of prognosis were analyzed,and the clinical characteristics and prognostic factors of patients with IE without underlying heart disease were also explored.Statistical analysis was performed using SPSS version 23.0.Results:A total of 405 patients with IE were enrolled,including 261 males(64.4%).The hospital mortality rate of IE patients was 10.1%,and the 1-year mortality rate was 10.6%.The average age was 48±16years old,and the age of IE onset showed an increasing trend yearly(P=0.001).The number of IE patients over 65 years old showed a significant increase(P=0.008).Among IE patients with underlying heart disease,congenital heart disease was the most common,with 105 cases(25.9%),followed by rheumatic heart disease,of which proportion showed a decreasing trend(P<0.001).A total of 52 patients(12.8%)underwent transesophageal echocardiography,and 30 patients were eventually diagnosed by transesophageal echocardiography.The blood culture positive rate was 68.6%,and streptococci was the main pathogen accounted for 27.2%.There were 183(45.5%)adults with IE without underlying heart disease,of which 27.3%(50/183)had chronic disease and 37.1%(68/183)had a predisposition.Compared with IE patients with underlying heart disease,patients without underlying heart disease had few right heart or whole heart involvement(P=0.001),and multiple valve involvement was less common(P<0.001);The incidence of cardiac complications such as heart failure,arrhythmia,and valve periarticular abscess was lower(P<0.05);there were no significant difference between the two groups in hospital mortality and 1-year mortality(P=0.225,P=0.247 respectively).Multivariate analysis for all IE patients showed pulmonary hypertension(P=0.005,OR=4·3,95%Cl 1.561-12.371),renal insufficiency(P=0.004,OR=4.141,95%CI 1.572-10.909)and Pitt score>4(P<0.001,OR=59.144,95%CI 13.439-260.293)were independent risk factors for in-hospital mortality.Cox regression analysis showed that antibiotic therapy combined with surgical treatment could not improve the one-year prognosis(P=0.402).Conclusions:In the past ten years,the age of IE onset has increased,and the number of elderly IE patients has gradually increased.The proportion of patients with IE without underlying heart disease is high,and many of these patients have chronic diseases or predisposing factors.Transesophageal echocardiography and surgery are underused in the diagnosis or treatment of IE.The positive blood culture is low.Pulmonary hypertension,renal dysfunction and Pitt score>4 are independent risk factors for in-hospital mortality.Surgical treatment cannot improve the one-year prognosis of patients with IE.