A Retrospective Study on the Predictors of Outcome in Patients with Infective Endocarditis

Background : Infective endocarditis (IE) is associated with signi fi cant mortality and morbidity. This study aims to up-date the epidemiology of IE and to identify predictors of adverse outcome in the Chinese population in Hong Kong. Methods : This was a single-centre retrospective study of patients diagnosed with IE in Princess Margaret Hospital in Hong Kong during 2002 e 2016. Primary outcome was de fi ned as in-hospital mortality. Secondary outcomes included 1-year mortality, valvular surgical intervention, heart failure, stroke and systemic embolization. Results : In total, 196 patients with de fi nite or possible IE were included in the study. The incidence of IE was 2.26 per 100,000 person-years and had remained stable. Health care-associated IE (HCAIE) accounted for 32% of cases, with an increasing trend. Staphylococcus aureus was the most frequently isolated organism in the overall study population (37.8%) and among intravenous drug users (85.2%). In-hospital mortality remained high (29.1%) and was independently associated with higher Charlson Comorbidity Index (OR 1.24, p ¼ 0.001), heart failure (OR 5.65, p < 0.001) and the presence of large vegetation ≥ 1 cm (OR 4.67, p < 0.001). IE due to Streptococcus viridans was associated with a better outcome (OR 0.40, p ¼ 0.048). Discussion : This study showed that the incidence of IE remained stable during 2002 e 2016. There was an increasing proportion of HCAIE and S. aureus has become the most common causative organism. IE was associated with high mortality and morbidity. Independent predictors for in-hospital mortality were patient ' s medical comorbidity, large vegetation size and heart failure, while infection by viridans group streptococci was associated with reduced risk.