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. 7%, 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-acquired endocarditis. The presence of vegetations and their size were significant predictors of major embolic events and mortality. Staphylococcus aureus was a predictor of mortality (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.