Clinical predictors of mortality in hospitalized patients with infective endocarditis at a tertiary care center in Pakistan

Objective: To evaluate the clinical characteristics and predictors of in-hospital mortality in patients with infective endocarditis at a tertiary care centre in Pakistan. Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from January 1, 2002, to December 31, 2006, and comprised 84 consecutive patients hospitalised with infective endocarditis,. All patients underwent verification of the diagnosis according to the Modified Duke criterion. Data was collected through a questionnaire and analysed using Student's t test, Chi square and Fisher's exact test. Univariate and multivariate logistic regression analysis was performed to assess predictors of mortality. Results: Of the total, 53(63%) patients were male and 31(37%) female. The mean age of the patients was 42±17 years. Overall, 34(41%) patients had rheumatic valve disease as a predisposing condition. The most commonly affected valve was mitral in 43(51%) patients, and the most commonly isolated organism was methicillin-resistant staphylococcus aureus in 12(14.3%).. Overall in-hospital mortality was 27(32.1%), while 18(21%) patients developed congestive cardiac failure, 15(18%) developed arrhythmias, 16(19%) developed peripheral embolism and renal failure was present in 38(54%). Besides, 17(20%) patients underwent surgical intervention. The final multivariate model that can be used to predict mortality in this study consisted of the presence of neurological complications (p <0.001) Odds Ratio 7.26, Confidence Interval (2.27-23.18), congestive cardiac heart failure (p <0.023) Odds Ratio 5.39, Confidence Interval (1.26-23.04), and arrhythmias (p <0.034) Odds Ratio 4.21, Confidence Interval (1.11-15.88). Conclusion: Significant predictors of mortality in hospitalised patients with infective endocarditis in our study were the presence of neurological complications, congestive cardiac heart failure, and the presence of arrhythmias.