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Valvular heart disease
Original research
Infective endocarditis at a tertiary care hospital in South Korea
  1. Jung Ho Kim1,
  2. Hi Jae Lee2,
  3. Nam Su Ku1,
  4. Seung Hyun Lee2,
  5. Sak Lee2,
  6. Jun Yong Choi1,
  7. Joon-Sup Yeom1
  1. 1 Department of Internal Medicine and AIDS Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
  2. 2 Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
  1. Correspondence to Dr. Nam Su Ku, Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; smileboy9{at}yuhs.ac; Dr. Seung Hyun Lee, Division of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; henry75{at}yuhs.ac

Abstract

Objective The treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.

Methods A 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.

Results We included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused by Staphylococcus aureus (OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, p<0.001) and was associated with improved long-term prognosis compared with medical treatment only (p<0.001).

Conclusions The incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE.

  • endocarditis
  • valve disease surgery
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/heartjnl-2020-317265

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    Footnotes

    • Presented at This study was accepted and presented in the form of a poster presentation at the IDWeek 2019 Annual Meeting, Washington, District of Columbia, 2–6 October 2019. Our abstract presented at IDWeek 2019 can be found at Open Forum Infectious Diseases, Volume 6, Issue Supplement 2, October 2019, pages S100–S101.

    • Contributors NSK and SHL contributed to the conception and design of the study. JHK, HJL and SL contributed to data acquisition and analysis. JHK, NSK and SHL performed statistical analysis of the data. JHK wrote the first draft. NSK, SHL, SL, JYC and J-SY contributed to the review and editing of the manuscript. NSK and SHL are responsible for the overall content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the institutional review board of Yonsei University Health System Clinical Trial Center (4-2018-0248).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

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    © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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