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2015 ; 5
(1
): 45
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Infective endocarditis requiring ICU admission: epidemiology and prognosis
#MMPMID26621197
Leroy O
; Georges H
; Devos P
; Bitton S
; De Sa N
; Dedrie C
; Beague S
; Ducq P
; Boulle-Geronimi C
; Thellier D
; Saulnier F
; Preau S
Ann Intensive Care
2015[Dec]; 5
(1
): 45
PMID26621197
show ga
BACKGROUND: Very few studies focused on patients with severe infective
endocarditis (IE) and multiple complications leading to Intensive Care Unit (ICU)
admission. Studied primary outcomes depended on the series and multiple
prognostic factors have been identified. Our goal was to determinate
characteristics of patients, in-hospital mortality and independent prognostic
factors in an overall population of patients admitted to ICU for a left-sided,
definite, active and severe IE. METHODS: Retrospective study performed in 9 ICUs
during an 11-year period. RESULTS: Data of 248 patients (mean
age = 62.4 ± 13.3 years; 63.7 % male) were studied. Native and prosthetic valves
were involved in 195 and 53 patients, respectively. Causative pathogens,
identified in 225 patients, were mainly streptococci (45.6 %) and staphylococci
(43.4 %). On ICU admission, 127 patients exhibited extra-cardiac involvement.
Ninety-five patients had one or more neurological complications, as followed:
ischemic stroke (n = 66), cerebral hemorrhage (n = 31), meningitis (n = 16),
brain abscess (n = 16), and intracranial mycotic aneurysm (n = 10). Criteria
prompting to cardiac surgery appeared during ICU stay for 186 patients and
between ICU and hospital discharges in 5 patients. Due to contra-indications,
surgery required by IE was only performed during hospitalization in 125 patients.
Moreover, surgery was considered adequate according to usual guidelines in 76 of
191 patients with indication(s) of valvular surgery: for patients with surgical
procedure considered as emergency (n = 69), 17 surgical procedures underwent
within the first 24 h following indication; for patients with urgent surgical
indication (n = 102), surgery was performed during the first week following
indication in 40 patients; finally, elective surgery (n = 20) was performed for
19 patients. During hospitalization, 103 (41.5 %) patients died. Four independent
prognostic factors were identified: SAPS II > 35 (AOR = 2.604; 95 % CI:
1.320-5.136; p = 0.0058), SOFA > 8 (AOR = 3.327; 95 % CI: 1.697-6.521;
p = 0.0005), IE due to methicillin resistant Staphylococcus aureus (AOR = 4.981;
95 %CI = 1.433-17.306; p = 0.0115) and native IE (AOR = 0.345; 95 % CI:
0.169-0.703; p = 0.0034). CONCLUSIONS: Mortality in patients admitted to ICU for
left-sided IE remains high, especially in cases of endocarditis due to
methicillin resistant Staphylococcus aureus, when organ failures occur and ICU
scores are high.
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