What are the main predictors of in-hospital mortality in patients with infective endocarditis: a review.

Objectives: Infective endocarditis (IE) has a high 30-day mortality. Surgery is needed in many patients. The preoperative hemodynamic status (congestive heart failure, need for urgent/emergent surgery or mechanical support, NYHA class III/IV) could have an impact on postoperative outcome. Each of these parameters is an indication for the inadequacy of the left ventricle to maintain an adequate circulation Methods. A literature search was performed using "endocarditis AND hospital mortality OR outcome AND predictor" and "International Collaboration on Endocarditis - Prospective Cohort Study" in Web of Science database, from 2010-2017. The focus was hospital mortality and its predictors. Manuscripts were excluded if no logistic regression or propensity analysis was available. The predictors were ranked according the odds ratios. Articles with risk scores based on multivariate analysis were also added.

Results: Most studies are coming from one tertiary center and are retrospective, with different designs. Recruitment periods are long and sample sizes small. Definitions of preoperative events such as hemodynamic status are not uniform. Thirty-day mortality varies between 10 and 50%. In 8 of 18 papers where the hemodynamic status is included, it is ranked as first and in 3 as second. The scoring systems confirm in several occasions the importance of left ventricular factors.

Discussion: The heterogeneity of the included papers and lack of uniform definitions of preoperative events precludes a proper meta-analysis. Nevertheless, heart failure and a compromised hemodynamic status can be identified as the dominant predictor for 30-day mortality of IE. This seems avoidable by early surgery.