Clinical Presentation and Outcome of Infective Endocarditis: A Five-year Experience at Chaophya Abhaibhubejhr Hospital, A Provincial Community Hospital in Thailand

Abstract

BACKGROUND: Infective endocarditis has a broad clinical manifestation with multi-organ involvement. Infective endocarditis is common in developing countries and can lead to open heart surgery as well as other serious complications such as stroke, or death.

OBJECTIVES: This study investigates the clinical characteristics, outcomes, and predictors of adverse events in patients diagnosed with IE at Chaophya Abhaibhubejhr Hospital.

METHODS: We conducted a prospective cohort study among patients who underwent echocardiography from October 1, 2017, to November 30, 2022, and were diagnosed with infective endocarditis. Demographic and clinical data, such as signs, symptoms, complications, laboratory results, and treatment, were collected and summarized. Risk factors for inpatient mortality and embolic phenomenon were determined by logistic regression analysis.

RESULTS: Of the 8,098 patients who underwent transthoracic echocardiography, 65 patients (0.8%) with infective endocarditis were identified. Forty-four were men (67.7%) with a median (Interquartile range (IQR) age of 51 years (41-62). A total of 26 (40%) had essential hypertension, 16 (24.6%) had chronic kidney disease, 8 (12.3%) received renal replacement therapy, and 13 (20%) had diabetes. Fever was present in 95.4% of cases, with a median (IQR) fever duration of 72 hours (48–336) before diagnosis. Heart failure was observed in 35 patients (53.5%), 14 (21.5%) needed an intensive care unit at presentation, and the median (IQR) APACHE II score was 11 (6-16). The majority were native valves (95.4%), and valve involvement comprised mitral valves (63.1%), aortic valves (27.7%), and tricuspid valves (9.2%), respectively. The Median (IQR) vegetation size was 9 millimeters (5-12), and the left ventricular ejection fraction was 64% (57-68%). Causative pathogens were Streptococcus spp. (40%) followed by Staphylococcus spp. (35.4%), and the median (IQR) time to positive hemoculture was 12 hours. Overall inpatient mortality was 12.3%. The common embolic phenomenon was ischemic stroke (23.1%), followed by meningitis (18.5%). By multivariate analysis, the associated factor for inpatient mortality was chronic renal failure (odds ratio 23.51, p=0.04), and the associated factor for stroke was the alteration of consciousness at presentation (odds ratio 17.67, p=0.004).

CONCLUSIONS: At the authors’ center, patients with infective endocarditis typically present with fever and congestive heart failure. The average age at diagnosis is 51 years, with the mitral valve being the most affected. The inpatient mortality rate is 12.3%, and 21.5% require ICU admission. Chronic renal failure is also a predictor of poor outcomes.

Thaiclinicaltrials.org number, TCTR20250216015