Predictors of inhospital mortality in patients with infective endocarditis

Despite advances in therapy, infective endocarditis (IE) remains a serious disease with high mortality. We evaluated 155 Egyptian patients with Duke definite/possible IE to determine incidence, causes and predictors of inhospital mortality. The mean time from symptoms onset to diagnosis was 66.4 ± 97 days. The causes of mortality (38.7%) included congestive heart failure (CHF), sepsis, surgery related, stroke, cerebral hemorrhage, pulmonary embolism, sudden cardiac death, and hyperkalemia. Predictors of mortality on univariate analysis were duration of symptoms before hospital admission (p = 0.017), health care associated endocarditis (p = 0.039), CHF (p < 0.001), fulminant sepsis (p < 0.001), embolization (p = 0.011), need for dialysis (p = 0.003), need for cardiac surgery (p = 0.027), unperformed indicated cardiac surgery (p = 0.002) and higher C-reactive protein level (p = 0.05). In multivariate analysis, only CHF remained an independent predictor of mortality (p = 0.033). IE mortality was high in this cohort probably due to delayed diagnosis. Patients having these mortality predictors especially CHF deserve more aggressive treatment.