| Abstract [eng] |
Infective endocarditis (IE) is a rare disease with a worldwide incidence of 3-10/100,000/year and a prevalence of 5.6/100,000 in 2019 (1). It is related to high morbidity, connected to systemic complications and a generally high mortality rate, about 25%. (5) In summary, those numbers highlight the importance of identifying risk factors for mortality to improve these numbers, not only in Lithuania but also over the world. The aim of this study was to evaluate the mid- and long-term survival, the freedom from reinfection and the incidence of IE patients undergoing open-heart surgery in Vilnius, Lithuania. In addition, factors for mortality in these cases were sought to be identified. The objective of this study was to conduct an international comparison and assessment of the operative outcomes for infective endocarditis, in line with similar studies conducted in various other countries. A retrospective observational single-center study data collection between January 2011 and December 2022 was done, with 294 cases by reviewing medical records of the hospital database, using standardized forms. Patients under 18 years of age and cases without follow-up were excluded. Patients were followed up till the 2023/06/01. Primary outcome was mortality from any cause, secondary outcomes were absence of reinfection or postoperative complications. A multivariate binary logistic regression analysis was performed to assess the independent risk factors for mortality. Significant factors were analyzed by univariant model of Cox regression. 294 cases were analyzed. The median incidence was 25 cases/year without significant trend in numbers. 9.0% died in first 30 days after operation. 1-year survival was 83.0%, 10-year survival 60.0%. Freedom of reinfection after 5-years was 95.3%, after 10 years 91.5%. Significant variables in the 1-year analysis are moderate impaired creatinine clearance (p 0.019, 95% CI 1.176-5.935, HR 2.642), preoperative dialysis (p 0.000, 95% CI 3.553-16.941, HR 7.758), and fungal infection (p 0.001, 95% CI 1.892-14.692, HR 5.272). Postoperatively factors were a therapy with extracorporeal membrane oxygenation (p 0.000, 95% CI 9.936-49.698, HR 22.222), renal replacement therapy (p = 0.000, 95% CI 5.429-16.999, HR 9.607), stroke (p 0.000, 95% CI 3.366-13.300, HR 6.691), tracheostomy (p 0.000, 95% CI 5.195-19.068, HR 9.953). For the overall follow up time preoperative factors were dialysis (p 0.000, 95% CI 2.107-8.741, HR 4.291), left ventricular ejection fraction ≤ 20% (p 0.000, 95% CI 3.410-61.368, HR 14.465), pulmonary edema (p 0.000, 95% CI 1.401-3.123, HR 2.092), inotropic support (p 0.000, 95% CI 2.138-7.638, HR 4.041), and fungal infection (p 0.000, 95% CI 2.174-13.485, HR 5.414). Heterogeneity analysis of gender and age groups revealed no significance. The incidence in Vilnius showed no significant over the past years. The mortality risk was in overall acceptable. Significant variables highlight the interference of mortality and the renal-cardiovascular system, leading to the conclusion of the implementation of better preoperative – renal focused - monitoring, and close surveillance of neurological deficits and alertness. |
