Predictors of In-hospital Adverse Events in Patients with Prosthetic Valve Infective Endocarditis

Abstract

Background: We aimed to study patients with prosthetic valve endocarditis (PVE) and analyse factors associated with in-hospital adverse events.

Methods: A review of all patients who underwent echocardiography at a local university hospital with definite PVE (modified Duke's criteria) was performed. Adverse events of in-hospital mortality and redo valve surgery were identified.

Results: There were 23 patients with PVE (median age 53 years (IQR:38-66), 12 males (52%)). Twelve adverse events occurred including seven (30%) in-hospital mortalities and five (21%) redo valve surgery. Factors associated with in-hospital mortality include Staphylococcus aureus-PVE (86% vs 31%, p=0.027), presence of shock (86% vs 19%, p=0.005) and intensive care unit admission (72% vs 19%, p=0.026). Factors associated with the need for redo valve surgery include a younger median age (37 vs 61 years, p=0.012), longer median length of stay (58 vs 17 days, p=0.004), history of intravenous drug abuse (IVDA) (60% vs 6%, p=0.021) and right-sided valvular involvement (40% vs 0%, p=0.040). Using a composite endpoint of both outcomes, factors associated with in-hospital adverse events were a history of IVDA (36% vs 0%, p=0.037) and presence of shock (64% vs 17%, p=0.036).

Conclusion: PVE carries a high risk of poor clinical outcome in terms of in-hospital mortality and the need for redo surgery.

Keywords: Adverse events; In-hospital mortality; Infective endocarditis; Predictors; Prosthetic valve; Redo valve surgery.