engleski

Association between valvular surgery and mortality among patients with infective endocarditis complicated by severe sepsis and septic shock

Severe sepsis and septic shock are common complications of infective endocarditis (IE). A prospective, single-center observational study in patients with definite native or prosthetic valve IE admitted between January 1, 2000 and December 31, 2011. The main objective of the study was estimate the safety of valve replacement in patients with severe sepsis and/or septic shock and its impact on patients' outcome. We compared clinical characteristics and outcome (in-hospital mortality)in surgically and only medically treated patients stratified on the severity of sepsis. The cohort included 294 patients with definite IE known septic status enrolled. Patients were stratified into two groups. There were 95 (32.3%) patients with severe sepsis and/or septic shock (SSS) and 199 (67.7%) with sepsis (S). Valve replacement was performed in 37(38.9%) patients in the SSS group, and 71 (35.7%) in the S group, p=0.587. APACHE II score was significantly higher among medically treated patients. The mortality in SSS group was significantly higher in medically treated patients, 39/58 (67.2%) vs. 5/37 (13.4%), p<0.001. After adjusting for APACHE II score, SOFA score, age, and congestive heart failure, the beneficial impact of cardiac surgery remained significant. Cardiac surgery decreased the risk of in-hospital death about five times in SSS group, OR=0.096, 95%CI 0.027-0.335. Even in the most severe septic patients with IE, cardiac surgery improves patients' outcome. SOFA score is a better predictor of patients' outcome than APACHE II score, and should be included in the evaluation of IE patients.

iInfective endocarditis; cardiac surgery; sepsis

doi:10.1016/S0924-8579(13)70048-7