Clinical Characteristics and Risk Factors for in-Hospital Mortality in 240 Cases of Infective Endocarditis in a Tertiary Hospital in China: A Retrospective Study

Figures & data

Figure 1 Definite diagnosis of IE according to the modified Duke criteria.

Table 1 Clinical Features, Echocardiography and Microbiology of 240 IE Cases

Variables	n (%)	Variables	n (%)
Male	154 (64.2)	Echocardiographic data
Clinical manifestations		Vegetation size ≥ 10mm	116 (48.3)
Fever	189 (78.8)	Mitral location	124 (51.7)
Chest tightness/asthma	104 (43.3)	Aortic location	116 (48.3)
Cardiac murmur	205 (85.4)	Multivalvular infection	49 (20.4)
Predisposing factors		Prosthetic valves infection	21 (8.8)
CHD	51 (21.3)	Valvular perforation	37 (15.4)
RHD	21 (8.8)	Paravalvular abscess	28 (11.7)
Previous heart valve surgery	23 (9.6)	Moderate or severe valve stenosis	17 (7.1)
Comorbidities		Rupture of chordae tendinca	20 (8.3)
Hypertension	60 (25.0)	Complications
Diabetes	30 (12.5)	Intracranial infection	14 (5.8)
Renal disease	8 (3.3)	Septic shock	6 (2.5)
Liver disease	7 (2.9)	Splenomegaly	48 (20.0)
History of cancer	11 (4.6)	Cerebral hemorrhage	18 (7.5)
Dialysis	5 (2.1)	Cerebral emboli	21 (8.8)
Intravenous drug use	2 (0.8)	Atrial fibrillation	22 (9.2)
Surgical treatment	173 (72.1)	NYHA class III–IV	90 (37.5)
In-hospital mortality	15 (6.3)	One-year mortality	19 (7.9)

Figure 2 Results of blood culture in 240 IE patients.

Table 2 Characteristics of 240 Patients with IE in the Three Age Groups

Variables, n (%)	Group A (N=104)	Group B (N=103)	Group C (N=33)	P-value
				A vs B	B vs C	A vs C
Male	66 (63.5)	69 (67.0)	19 (57.6)	0.594	0.325	0.544
Clinical manifestations
Fever	82 (78.8)	79 (76.7)	28 (84.8)	0.710	0.320	0.450
Chest tightness/asthma	37 (35.6)	52 (50.5)	15 (45.5)	0.030*	0.615	0.308
Cardiac murmur	90 (86.5)	87 (84.5)	28 (84.8)	0.672	0.958	0.807
Predisposing factors
CHD	31 (29.8)	18 (17.5)	2 (6.1)	0.037*	0.107	0.005*
RHD	6 (5.8)	12 (11.7)	3 (9.1)	0.133	0.683	0.502
Previous heart valve surgery	10 (9.6)	9 (8.7)	4 (12.1)	0.827	0.565	0.679
Comorbidities
Hypertension	9 (8.7)	30 (29.1)	21 (63.6)	<0.001*	<0.001*	<0.001*
Diabetes	6 (5.8)	19 (18.4)	5 (15.2)	0.005*	0.666	0.084
Renal disease	2 (1.9)	3 (2.9)	3 (9.1)	0.643	0.133	0.056
Liver disease	4 (3.8)	1 (1.0)	2 (6.1)	0.178	0.083	0.588
History of cancer	3 (2.9)	4 (3.9)	4 (12.1)	0.691	0.080	0.036*
Dialysis	3 (2.9)	1 (1.0)	1 (3.0)	0.317	0.392	0.965
Complications
Intracranial infection	8 (7.7)	5 (4.9)	1 (3.0)	0.400	0.657	0.346
Septic shock	2 (1.9)	2 (1.9)	2 (6.1)	0.992	0.223	0.219
Splenomegaly	31 (29.8)	14 (13.6)	3 (9.1)	0.005*	0.496	0.016*
Cerebral hemorrhage	8 (7.7)	9 (8.7)	1 (3.0)	0.784	0.274	0.346
Cerebral emboli	10 (9.6)	9 (8.7)	2 (6.1)	0.827	0.624	0.529
Atrial fibrillation	3 (2.9)	11 (10.7)	8 (24.2)	0.026*	0.050	<0.001*
NYHA class III–IV	38 (36.5)	38 (36.9)	14 (42.4)	0.958	0.569	0.544
Echocardiographic data
Vegetation size ≥ 10mm	42 (40.4)	62 (60.2)	12 (36.4)	0.004*	0.017*	0.680
Mitral location	53 (51.0)	54 (52.4)	17 (51.5)	0.833	0.927	0.956
Aortic location	53 (51.0)	47 (45.6)	16 (48.5)	0.443	0.775	0.804
Multivalvular infection	28 (26.9)	14 (13.6)	7 (21.2)	0.017*	0.292	0.512
Prosthetic valves infection	9 (8.7)	9 (8.7)	3 (9.1)	0.983	0.950	0.938
Valvular perforation	15 (14.4)	17 (16.5)	5 (15.2)	0.679	0.854	0.918
Paravalvular abscess	16 (15.4)	12 (11.7)	0	0.432	0.040*	0.017*
Moderate or severe valve stenosis	4 (3.8)	11 (10.7)	2 (6.1)	0.058	0.432	0.588
Rupture of chordae tendinca	8 (7.7)	12 (11.7)	1 (3.0)	0.335	0.143	0.346
Causative microorganism
Streptococcus spp.	28 (26.9)	23 (22.3)	4 (12.1)	0.443	0.201	0.080
Staphylococcus aureus	9 (8.7)	8 (7.8)	1 (3.0)	0.816	0.341	0.279
CoNS	5 (4.8)	4 (3.9)	2 (6.1)	0.744	0.596	0.776
Enterococcus	0	1 (1.0)	3 (9.1)	0.314	0.016*	0.002*
Gram-negative bacilli	6 (5.8)	3 (2.9)	3 (9.1)	0.314	0.133	0.502
Negative blood culture	57 (54.8)	63 (61.2)	16 (48.5)	0.354	0.199	0.526
Surgical treatment	80 (76.9)	76 (73.8)	17 (51.5)	0.601	0.017*	0.005*
In-hospital mortality	5 (4.9)	4 (3.9)	6 (18.2)	0.744	0.006*	0.014*

Note: *P<0.05.

Table 3 Risk Factors of In-Hospital Outcome in Patients with IE (Univariate Analysis)

Variables, n (%)	Survivors, N=225	Death, N=15	P-value
Age >65 y	27 (12.0)	6 (40.0)	0.002*
Male	143 (63.6)	11 (73.3)	0.444
Clinical manifestations
Fever	117 (52.0)	12 (80.0)	0.903
Chest tightness/asthma	99 (44.0)	5 (33.3)	0.420
Cardiac murmur	193 (85.8)	12 (80.0)	0.539
Predisposing factors
CHD	51 (22.7)	0	0.038*
RHD	19 (8.4)	2 (13.3)	0.516
Previous heart valve surgery	19 (8.4)	4 (26.7)	0.020*
Complications
Intracranial infection	9 (4.0)	5 (33.3)	<0.001*
Septic shock	3 (1.3)	3 (20.0)	<0.001*
Splenic embolization	5 (2.2)	3 (20.0)	<0.001*
Cerebral hemorrhage	13 (5.8)	5 (33.3)	<0.001*
Cerebral emboli	19 (8.4)	2 (13.3)	0.516
Atrial fibrillation	18 (8.0)	4 (26.7)	0.015*
NYHA class III–IV	80 (35.6)	10 (66.7)	0.016*
Echocardiographic data
Vegetation size ≥ 10mm	108 (48.0)	8 (53.3)	0.689
Mitral location	115 (51.1)	9 (60.0)	0.505
Aortic location	106 (47.1)	10 (66.7)	0.142
Multivalvular infection	45 (20.0)	4 (26.7)	0.535
Prosthetic valve infection	17 (7.6)	4 (26.7)	0.011*
Causative microorganism
Streptococcus spp.	54 (24.0)	1 (6.7)	0.122
S. aureus	15 (6.7)	3 (20.0)	0.058
CoNS	10 (4.4)	1 (6.7)	0.690
Enterococcus faecalis	3 (1.3)	1 (6.7)	0.118
Gram-negative bacilli	9 (4.0)	3 (20.0)	0.006*
Surgical treatment	167 (74.2)	6 (40.0)	0.004*

Note: *P<0.05.

Table 4 Risk Factors of In-Hospital Mortality in Patients with IE (Multivariate Analysis)

Variables	P-value	OR	95% CI
Age >65 y	0.005	13.357	2.220–80.345
Intracranial infection	0.004	19.397	2.586–145.500
Splenic embolization	0.015	26.493	1.906–368.186
Cerebral hemorrhage	0.008	12.851	1.959–84.326
NYHA class III–IV	0.016	7.636	1.471–39.644
Prosthetic valve infection	0.045	6.633	1.042–42.205