Contemporary epidemiology and prognosis of septic shock in infective endocarditis

• Published in: European heart journal 2013-07, Vol.34 (26), p.1999-2006
• Main Authors: Olmos, Carmen, Vilacosta, Isidre, Fernández, Cristina, López, Javier, Sarriá, Cristina, Ferrera, Carlos, Revilla, Ana, Silva, Jacobo, Vivas, David, González, Isabel, San Román, José Alberto
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - complications; Acute Kidney Injury - mortality; Cross Infection - complications; Cross Infection - mortality; Diabetes Complications - complications; Diabetes Complications - mortality; Echocardiography; Endocarditis, Bacterial - complications; Endocarditis, Bacterial - mortality; Female; Hospitalization; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Shock, Septic - complications; Shock, Septic - mortality; Staphylococcal Infections - complications; Staphylococcal Infections - mortality; Staphylococcus aureus; Tachycardia, Supraventricular - complications; Tachycardia, Supraventricular - mortality
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehs336

The prognosis of patients with infective endocarditis (IE) remains poor despite the great advances in the last decades. One of the factors closely related to mortality is the development of septic shock (SS). The aim of our study was to describe the profile of patients with IE complicated with SS, and to identify prognostic factors of new-onset SS during hospitalization. We conducted a prospective study including 894 episodes of IE diagnosed at three tertiary centres. A backward logistic regression analysis was undertaken to determine prognostic factors associated with SS development. Multivariable analysis identified the following as predictive of SS development: diabetes mellitus [odds ratio (OR) 2.06; confidence interval (CI) 1.16-3.68], Staphylococcus aureus infection (OR: 2.97; CI: 1.72-5.15), acute renal insufficiency (OR: 3.22; CI: 1.28-8.07), supraventricular tachycardia (OR: 3.29; CI: 1.14-9.44), vegetation size ≥15 mm (OR: 1.21; CI: 0.65-2.25), and signs of persistent infection (OR: 9.8; CI: 5.48-17.52). Risk of SS development could be stratified when combining the first five variables: one variable present: 3.8% (CI: 2-7%); two variables present: 6.3% (CI: 3.2-12.1%); three variables present: 14.6% (CI: 6.8-27.6%); four variables present: 29.1% (CI: 11.7-56.1%); and five variables present: 45.4% (95% CI: 17.5-76.6%). When adding signs of persistent infection, the risk dramatically increased, reaching 85.7% (95% CI: 61.2-95.9%) of risk. In patients with IE, the presence of diabetes, acute renal insufficiency, Staphylococcus aureus infection, supraventricular tachycardia, vegetation size ≥15 mm, and signs of persistent infection are associated with the development of SS.