Endocarditis, Who is Particularly at Risk for Mortality? Multicenter Data from the Brandenburg Endocarditis Registry (B.E.R.)

Background: In recent years, endocarditis has accounted for an increasing proportion of heart valve operations. Treatment is extremely complex and challenging in an aging society and with high multimorbidity, and the disease is often associated with severe progression and poorer outcomes despite treatment. The main aim of this study was to identify specific risk factors associated with mortality that confirm or complement the currently adapted endocarditis guidelines.

Methods: Data from 573 patients from our multicenter prospective endocarditis registry were analyzed regarding perioperative risk factors, comorbidities, microbiological, laboratory and imaging diagnostics, perioperative complications, and mortality including 1-year follow-up.

Results: 30-day mortality was 27% while 1-year mortality was 31%. The deceased patients were significantly older (p < 0.001), had significantly worse LVEF (p < 0.001), more heart failure (p < 0.001), coronary heart disease (p = 0.006), previous cardiac surgery (p = 0.046), immunodeficiency (p = 0.009), previous pulmonary infections (p < 0.001), periannular abscesses, valve perforation, and shunt (p < 0.001), and other preoperative complications such as SIRS, pulmonary edema, septic embolism, acute renal failure, delirium, and pleural effusions (<0.001 each). Preoperative anemia, leukocytosis, hypalbuminemia (p < 0.001), elevated bilirubin (p = 0.019), and inflammation and retention parameters and dysregulation of coagulation (p < 0.001) were also associated with increased mortality. Prolonged surgery time was also associated with increased mortality (p < 0.001).

Conclusion: Some risk factors such as hypalbuminemia or coagulation factor deficiencies can already be eliminated preoperatively. Others such as cardiac insufficiency, acute inflammation, or renal insufficiency can be controlled by careful preoperative preparation and careful planning of the operation. The operation itself should not be too extensive to reduce the overall surgical burden. Postoperative intensive and intermediate care treatment requires the utmost vigilance of all disciplines involved and regular endocarditis board meetings. The data show how demanding endocarditis patients are and how complex the treatment is, so that the use of an endocarditis team with a high level of expertise is essential and that this expertise should also be utilized by peripheral hospitals at an early stage of endocarditis.

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Artikel online veröffentlicht:
11. Februar 2025