In:
PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 9 ( 2023-9-8), p. e0290998-
Abstract:
Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. Methods Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. Results The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62–77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008–2013 and 29.9% in 2014–2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08–1.23), intracardiac abscess (OR:1.78, 95% CI:1.30–2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31–4.19), acute renal failure (OR: 3.11, 95% CI:1.14–2.09), septic shock (OR: 5.56, 95% CI:3.55–8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21–2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49–2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p 〈 0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus , septic shock, and stroke. Conclusions Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0290998
DOI:
10.1371/journal.pone.0290998.g001
DOI:
10.1371/journal.pone.0290998.g002
DOI:
10.1371/journal.pone.0290998.t001
DOI:
10.1371/journal.pone.0290998.t002
DOI:
10.1371/journal.pone.0290998.t003
DOI:
10.1371/journal.pone.0290998.t004
DOI:
10.1371/journal.pone.0290998.t005
DOI:
10.1371/journal.pone.0290998.s001
DOI:
10.1371/journal.pone.0290998.s002
DOI:
10.1371/journal.pone.0290998.r001
DOI:
10.1371/journal.pone.0290998.r002
DOI:
10.1371/journal.pone.0290998.r003
DOI:
10.1371/journal.pone.0290998.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
2267670-3
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