Abstract 12698: Long term Outcomes and Cardiac Surgery in Critically Ill Patients With Infective Endocarditis
Introduction: The aims are to assess long-term outcomes and management of patients admitted to ICU with left-sided IE, and to evaluate the impact of surgery.
Methods and Results: Among the 198 patients included prospectively for IE across 33 adult ICU in France from April 1st 2007 to October 1st 2008, 137 (69%) were dead at a median follow-up time of 59.5 months. Characteristics significantly associated with mortality were: Sequential Organ-Failure Assessment (SOFA) score at ICU admission (HR, 95% CI 1.43 (0.79-2.59); 2.01 (1.05-3.85); 3.53 (1.75-7.11) per quartile, P=0.003); prosthetic mechanical valve IE (HR 2.00; 95% CI 1.09-3.69, P=0.024); vegetation size ≥ 15mm (HR 1.64; 95% CI 1.02-2.63, P=0.038); and cardiac surgery (HR (95%CI), 0.33 (0.16-0.67); 0.61 (0.29-1.26); 0.42 (0.21-0.83) according to surgical timing, P=0.005). One hundred and three (52%) patients underwent cardiac surgery after a median time of 6 (16) days. Independent predictors of surgical intervention on multivariate analysis were: age ≤ 60 years (OR 5.30; 95% CI (2.46-11.41), P≤0.01), heart failure (OR 3.27; 95% CI (1.03-10.35), P=0.04), cardiogenic shock (OR 3.31; 95% CI (1.47-7.46), P=0.004), septic shock (OR 0.25; 95% CI (0.11-0.59), P=0.001), immunosuppression (OR 0.15; 95% CI (0.04-0.55), P=0.004), and diagnosis before or within 24 hours of ICU admission (OR 2.81; 95% CI (2.14-6.95), P=0.025). Pre-operative multi-organ failure, as assessed by the SOFA score, was the only factor independently associated with long-term post-operative mortality; the highest SOFA score predicted the poorest outcomes (HR 11.58, 95% CI 4.02-33.35, P≤0.0001). Surgical timing did not impact on postoperative outcomes. Of the 158 patients with a theoretical indication for surgery, the 58 deemed not fit had a 95% mortality rate.
Conclusion: Factors associated with long-term mortality in critical IE are the severity of multi-organ failure, prosthetic mechanical valve IE, vegetation size ≥ 15mm, and surgical treatment. Up to one third of potential candidates do not undergo surgery and these patients experience extreme mortality rates. Preoperative multiorgan failure score is the only factor associated with post-operative mortality, whilst surgical timing does not impact on outcomes.
- © 2013 by American Heart Association, Inc.