Prognosis of Infective Endocarditis According to Clinical Characteristics, Economic Status, and Center Experience

Abstract

Purpose: Infective endocarditis (IE) is a life-threatening disease with high morbidity and mortality rates. However, the risk factors for mortality in these patients require further study. This study aimed to evaluate the association of clinical outcomes of IE with patients’ clinical characteristics and economic status and treatment center experience using nationwide data. Materials and Methods: Data were collected from the National Health Insurance System of South Korea. Patients diagnosed with IE between 2003 and 2018 were included. Baseline characteristics, treatment, and survival outcomes were analyzed. Results: Among the 8487 patients included, 6617 (78.0%) had native valve IE, 1678 (19.8%) had prosthetic valve IE, and 192 (2.3%) had cardiac device-related IE (CDRIE). In-hospital mortality was 12.1±2.8% (121.3 deaths per 1000 IE case-years). In the multivariate analysis adjusted for variables significant in the univariate Cox regression, CDRIE, age ≥70 years, hypertension, diabetes, dialysis, cancer, immunosuppression, ischemic heart disease, atrial fibrillation, and complications such as hemorrhagic stroke, shock, and acute renal failure were independently associated with increased in-hospital mortality. Importantly, after multivariate adjustment, high-volume centers (≥20 IE cases/year) [hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.50–0.70, p<0.001] and high economic status (HR, 0.83; 95% CI, 0.72–0.95; p=0.010) were significantly associated with lower mortality compared to low-volume centers and low economic status, respectively. Conclusion: Mortality outcomes of IE were determined by multiple factors, including patients’ clinical characteristics, economic status, and center experience. Support for those with low economic status and establishment of well-experienced multidisciplinary teams may help to lower the risk of death in patients with IE.