Abstract 3453: Regional Variation in the Presentation and Outcome of Patients with Infective Endocarditis (IE): The International Collaboration on Endocarditis-Prospective Cohort Study
Background The International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) was designed to assess the current characteristics of patients with definite IE and to evaluate regional variation among those patients.
Methods The ICE-PCS prospectively identified and enrolled 2761 patients with definite IE from four worldwide regions (56 centers in 28 countries) from June 2000 through August 2005.
Results The median age in the study population was 58.0 years (IQR 43.5–71.8 years) and 68.6 % had native valve IE. Most patients (75.3%) had few of the typical hallmarks of IE. For instance, Roth spots (1.9 %), Osler’s nodes (2.1 %), Janeway lesions (5.1 %), and splinter hemorrhages (8.8 %) were uncommon at the time of first medical contact. Approximately 1 in 4 patients (23.0%) had recent health care contact prior to onset of their infection. Staphylococcus aureus was the most common pathogen (31.3 %). The mitral valve (46.7 %) was more commonly infected than the aortic valve (42.9 %). Complications were common: stroke (16.5 %); embolization other than stroke (21.9 %); heart failure (31.4%) and intracardiac abscess (14.0 %). Marked regional variation was found in almost all patient characteristics. The use of surgery was common (47.9 %) yet in-hospital mortality remained high (17.4 %). Notably, regions with the highest use of early surgery had the lowest in-hospital mortality while regions with a high use of late surgery had higher in-hospital mortality.
Conclusions Throughout much of the world IE is characterized by a high rate of S. aureus infection and approximately 1 in 4 patients have a history of recent health care prior to onset. Marked regional variation was found in the symptoms at the time of onset of medical care, treatment, and outcome of patients with IE. Despite a high use of surgery in this cohort, overall in-hospital mortality remains high. However mortality rates were lower in regions where early use of surgery was more common.