SPC365

Surgical Decision-Making in Infective Endocarditis: Predictors of In-Hospital Mortality

Session: Sessão de Comunicações Orais 12 – Doença Valvular Cardíaca: diagnóstico, estratificação de risco e abordagem terapêutica
Speaker: Joana Simões de Azevedo Massa Pereira

Congress: CPC 2026
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 16. Infective Endocarditis
Subtheme: 16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Joana Massa Pereira; Sofia Andraz; Lucas Hamann; Joana Guerreiro Pereira; Daniela Carvalho; Dina Bento; Raquel Fernandes; João Sousa Bispo; Hugo Alex Costa; Pedro Azevedo; Jorge Mimoso

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Background:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"> Infective endocarditis (IE) remains a life-threatening condition with in-hospital mortality rates of 13-26%. Early identification of patients at higher risk of adverse outcomes is crucial to guide clinical and surgical decision-making.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Objectives:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"> To identify independent predictors of in-hospital mortality in patients with IE managed in a real-world contemporary setting, and to evaluate the utility of EuroSCORE II for early risk stratification and surgical decision-making during the acute phase of the disease.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"> We conducted a retrospective study at a single tertiary center including all patients diagnosed with IE between January 2017 and December 2024. Mean follow-up was 20 &plusmn; 26 months. Surgical risk was stratified using EuroSCORE II with a 5% cut-off. The primary outcome was in-hospital mortality.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Results:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"> Eighty-seven patients were included (mean age 62 &plusmn; 16 years; 69% male). Low surgical risk (EuroSCORE &lt;5%) was present in 52 patients (60%), and high surgical risk (EuroSCORE &ge;5%) in 35 patients (40%). As expected, high-risk patients were older (70 &plusmn; 12 vs 57 &plusmn; 23 years, p&lt;0.001) and more frequently had previous cardiac surgery (45.7% vs 3.8%, p&lt;0.001). Prosthetic aortic valve endocarditis was significantly more common in the high-risk group (34.3% vs 0%, p&lt;0.001). These patients also more frequently developed heart failure (90.9% vs 29.2%, p&lt;0.001) and perivalvular abscess or fistula (38.2% vs 5.4%, p=0.021).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">In multivariate analysis, independent predictors of in-hospital mortality were age (OR 1.07; 95% CI: 1.01&ndash;1.14; p=0.031) and hemodynamic instability with shock (OR 15.33; 95% CI: 2.51&ndash;93.61; p=0.003). Surgical intervention was protective (OR 0.08; 95% CI: 0.01&ndash;0.51; p=0.008). EuroSCORE &ge;5% was <span style="font-family:&quot;Aptos&quot;,sans-serif">not</span> associated with in-hospital mortality (OR 1.47; 95% CI: 0.36&ndash;5.98; p=0.588), although it predicted mid- to long-term mortality (HR 2.49; 95% CI: 1.11&ndash;5.62; p=0.028). All patients requiring continuous renal replacement therapy died during hospitalization, preventing comparative statistical analysis.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Conclusions:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif"> Older patients and those presenting with shock represent a high-risk subgroup requiring urgent multidisciplinary evaluation and prompt surgical decision. Surgical intervention appears to confer a survival benefit even among patients with elevated predicted surgical risk. The absence of an association between EuroSCORE II and in-hospital mortality suggests that this tool is limited for short-term risk prediction in IE, and that clinical and infection-related factors should carry more weight than conventional surgical-risk scores when determining early operative strategies in</span></span></span></span>&nbsp;this setting.</p>