Trends of infective Endocarditis at two teaching hospitals: A 12-year retrospective cohort study in Rio de Janeiro, Brazil

• Published in: Tropical medicine and infectious disease Vol. 8; no. 12; pp. 1 - 11
• Main Authors: Damasco, Paulo Vieira, Solórzano, Victor Edgar Fiestas, Fortes, Natália Rodrigues Querido, Setta, Daniel Xavier de Brito, Fonseca, Aloysio Guimaraes da, Perez, Mario Castro Alvarez, Jazbick, João Carlos, Gonçalves-Oliveira, Jonathan, Horta, Marco Aurélio Pereira, de Lemos, Elba Regina Sampaio, Fortes, Claudio Querido
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland MDPI 01.12.2023; MDPI AG
• Subjects: Abscesses; Bacterial infections; Brazil; Care and treatment; Cohort analysis; Data processing; Endocarditis; Epidemiology; Evaluation; Health aspects; Heart; Hospital patients; Immunology; Industrialized nations; Infectious diseases; Infective endocarditis; Low income groups; Medical records; Medical research; Medicine, Experimental; Methicillin; Microorganisms; Missing data; Mortality; Observational studies; Patient monitoring; Patients; Prostheses; Regression analysis; retrospective cohort; Risk factors; Staphylococcus infections; Surgery; Teaching hospitals; Trends; Variables; Vegetation; Brazil; Rio de Janeiro Brazil; Brazil; mortality; endocarditis; retrospective cohort
• ISSN: 2414-6366; 2414-6366
• DOI: 10.3390/tropicalmed8120516

Background: Despite advances in diagnosis and treatment, the incidence and mortality of infective endocarditis (IE) have increased in recent decades. Studies on the risk factors for mortality in endocarditis in Latin America are scarce. Methods: This retrospective cohort study included 240 patients diagnosed with IE according to the modified Duke criteria who were admitted to two university hospitals in Rio de Janeiro, Brazil from January 2009 to June 2021. Poisson regression analysis was performed for trend tests. The multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) of predictors of in-hospital mortality. Findings: The median age was 55 years (IQR: 39-66 years), 57% were male, and 41% had a Charlson comorbidity index (CCI) score > 3. Healthcare-associated infective endocarditis (54%), left-sided native valve IE (77.5%), and staphylococcal IE (26%) predominated. Overall, in-hospital mortality was 45.8%, and mortality was significantly higher in the following patients: aged >= 60 years (53%), CCI score >= 3 (60%), healthcare-associated infective endocarditis (HAIE) (53%), left-sided IE (51%), and enterococcal IE (67%). Poisson regression analysis showed no trend in in-hospital mortality per year. The adjusted multivariate model determined that age >= 60 years was an independent risk factor for in-hospital mortality (HR equivalent 1.9; 95% CI 1.2-3.1; p equivalent 0.008). Interpretation: In this 12-year retrospective cohort, there was no evidence of an improvement in survival in patients with IE. Since older age is a risk factor for mortality, consensus is needed for the management of IE in this group of patients.