| Background and aims:Infective endocarditis(IE)is an infectious disease of the cardiac valves and endocardium.Though some progress made in the diagnosis and treatment of IE,the morbidity and mortality are still high.Previous studies showed a variety of prognostic factors of IE.Therefore,we designed this retrospective study to analyze the clinical characteristics of IE and explore the risk factors for 6-month mortality.Methods:We enrolled all initially confirmed or suspected IE patients who were hospitalized in the First Affiliated Hospital of Zhejiang University School of Medical from January 2011 to December 2018.The clinical baseline data,laboratory examination,echocardiography,surgical treatment,hospital complications and long-term follow-up were recorded.The primary end point was defined as all-cause death.Secondary end points included recurrent IE,unplanned readmission for valve surgery,heart failure and embolism after discharge.The total IE was divided into NVE group and PVE group,and the clinical characteristics and survival outcomes were compared.The clinical characteristics were also compared between patients had died and alive at 6-month follow up.Cox single-and multiple-factor regression analysis was used to investigate the independent risk factors for 6-month death.Kaplan Meier method was used to draw the survival curves of NVE group and PVE group,definite IE group and suspected IE group,each independent risk factor group,and the difference was compared using log-rank test.Results:A total of 412 patients who met the inclusion and exclusion criteria enrolled the study,including 380 NVE patients and 32 PVE patients.The median follow-up time was 876.0(439.0-1844.0)days.The incidence of acute heart failure,embolism,death in hospital and 6-monthmortality in NVE group were3.4%,6.1%,2.1%,9.2% and in PVE were3.1%,6.3%,3.1%,18.8%,respectively.There was no statistical difference in above contrast.While the long-term(more than 7 years)survival rate of NVE group was significantly higher than that of PVE group(P = 0.025).Multivariate Cox regression analysis showed that age > 70 years old,acute renal injury,peripheral arterial embolism,fungal blood culture results,high-sensitivity C-reactive protein ?77.1mg/l,glomerular filtration rate < 15 ml /(min · 1.73 ?)were independent risk factors for 6-month mortality.Conclusion: 1.Less than half of IE with underlying heart disease.Pulmonary infection,hypertension,diabetes mellitus and chronic kidney disease are common comorbidities other than heart disease.2.Fever is the most common symptom in IE,and other common symptoms include chest distress,shortness of breath,cough,expectoration,fatigue and arthralgia.3.Only 33.1% of IE had positive blood culture,so echocardiogram positive for IE plays an important role in the diagnosis of IE.4.Streptococcus is still the main pathogen of IE,while Staphylococcus aureus and Staphylococcus are the most common pathogens of PVE.5.There was no significant difference in 6-month mortality between NVE and PVE.But the long-term survival rate of PVE was lower than that of NVE.6.Age > 70 years old,acute renal injury,peripheral arterial embolism,fungi,high-sensitivity C-reactive protein ? 77.1mg/l,glomerular filtration rate < 15 ml /(min · 1.73 ?)were independently related to IE 6-month mortality. |
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