A Changing Profile Of Infective Endocarditis At A Tertiary Hospital In China

Background:Infective endocarditis(IE)is a lethal disease which has been changing significantly over the past decades.With the gradual improvement of diagnosis and treatment techniques,the mortality rate has not decreased accordingly.The clinical characteristics of infective endocarditis have undergone tremendous changes in the past few decades.The changes are also distinguished in different region depending on economic level and the environment.However,information about IE in China remains scarce.This study surveyed aimed to profile the changes in clinical characteristics of IE patients executively admitted to a tertiary hospital in south China over a period of nearly 18 years.Methods:Medical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in a tertiary hospital in south China.Data were divided by admission time into two groups equally:the early-period group,June 2001 to December 2009 and the later-period group,January 2010 to July 2018,and analyzed the differences of the clinical characteristics between two groups.Univariate factor analysis and binary logistic regression analysis were used to select the most useful predictors of the in-hospital mortality.Results:A Total of 313 IE patients were included in our study.The two groups presented similar clinical features,such as fever,heart murmurs,hypoalbuminemia,anemia,chest pain,cardiac insufficiency,embolism and hemorrhagic stroke.However,there were some differences of importance.In the later-period group,patients of intravenous drug users(IVDUs)related endocarditis decreased sharply,which brought along with a series of changes.Compared with the early-period group,patients in the later-period group included fewer intravenous drug users,older age at onset,reduced development of pulmonary embolism,less renal dysfunction,decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography.We also observed a higher proportion of ischemic strokes in the later-period group,which probably be related to the elder age.In addition,the later-period group presented a and higher proportion of positive transthoracic echocardiography(TTE)results and microbiological findings compared with the early-period group.The in-hospital mortality remained about the same between the two periods in spite of the clinical changes in 18 years.The multivariate analysis identified intravenous drug addicted,prosthetic valve endocarditis,hemorrhagic stroke,acute congestive heart failure,renal insufficiency,left-sided endocarditis,early surgical treatment as independent predictors of in-hospital mortality,in which early surgical treatment is the only protective factor.Conclusions:Our study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality.The geographic variations observed in our study will be of important value to profile the clinical feature of South China and offer the reference for clinical decisions in our region.