Clinical and echocardiographic predictors of morbidity and mortality in infective endocarditis: The significance of vegetation size

Background: Infective endocarditis is a common disease with significant morbidity and mortality. Objectives: To define clinical and echocardiographic parameters Predicting morbidity and in-hospital mortality in patients with infective endocarditis hospitalized in a tertiary hospital from 1991 to 2000. Methods: All patients with definite infective endocarditis diagnosed according to the Duke criteria were included. We examined relevant clinical features that might influence outcome. Results: The study group comprised 100 consecutive patients, 77 with native valve and 23 with prosthetic valve endocarditis. The overall in-hospital mortality rate was 8%. There was a higher mortality in the PVE group compared to the NVE group (13% vs. T%, P = 0.07). The mortality rate in each group, with or without surgery, was not significantly different, Clinical predictors of mortality were older age and hospital-aquired endocarditis. The presence of vegetations and their size were significant predictors of major embolic events and mortality. Staphylococcus aureus was a predictor of mortalfty (25% vs, 5%, P < 0.005) and abscess formation. Multivariate logistic analysis identified vegetation size and S. aureus as independent predictors of mortality. Conclusions: Mortality is higher in older hospitalized patients. S. aureus is associated with a poor outcome. Vegetation size is an independent predictor of embolic events and of a higher mortality.