Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases
Background: Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The aim of this study was to analyse the frequency and outcome of IE in contemporary CHD patients based on all IE hospital admi...
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| Format: | Article |
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MDPI AG
2021-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/21/5071 |
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| author | Maarja Maser Eva Freisinger Leo Bronstein Jeanette Köppe Stefan Orwat Gerrit Kaleschke Helmut Baumgartner Gerhard-Paul Diller Astrid Lammers |
| author_facet | Maarja Maser Eva Freisinger Leo Bronstein Jeanette Köppe Stefan Orwat Gerrit Kaleschke Helmut Baumgartner Gerhard-Paul Diller Astrid Lammers |
| author_sort | Maarja Maser |
| collection | DOAJ |
| description | Background: Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The aim of this study was to analyse the frequency and outcome of IE in contemporary CHD patients based on all IE hospital admissions in Germany over a 10-year period. Methods: Based on data of all hospital admissions in Germany from 2009 to 2018, we identified all CHD cases with a diagnosis of IE. The data contained information on patient demographics, diagnoses, surgical procedures, and mortality. The primary endpoint of the study was endocarditis-associated mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis, renal dialysis, resuscitation, or intubation). Results: Overall, 309,245 CHD inpatient cases were included in the analysis (underlying heart defects of simple complexity 55%, moderate complexity 23%, and complex heart defects 22%, respectively). Of those, 2512 (0.8% of all inpatient cases) were treated for IE. The mortality rate of IE inpatient cases was 6% with a major adverse events rate of 46%, and 41.5% of cases required surgical intervention. The overall IE associated mortality was lower in adult CHD cases compared to the 153,242 in adult IE cases without CHD (7.1% vs. 16.1%, <i>p</i> < 0.001). After adjustments using multivariable logistic regression analysis, the presence or complexity of CHD was not associated with the outcomes. Meanwhile, age, male sex, and co-morbidities emerged as significant predictors of adverse outcomes. Conclusions: IE accounts for a minority of CHD related hospitalizations but remains a deadly disease, and major adverse events are common in this setting. Due to different demographic and co-morbidity spectrums, adult CHD patients tend to have better survival prospects when compared to non-CHD IE patients. Acquired co-morbidities emerged as the main predictors of adverse outcomes. |
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| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T05:59:18Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-fe5919dd2807405fa062798151d9f1502023-11-22T21:06:54ZengMDPI AGJournal of Clinical Medicine2077-03832021-10-011021507110.3390/jcm10215071Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis CasesMaarja Maser0Eva Freisinger1Leo Bronstein2Jeanette Köppe3Stefan Orwat4Gerrit Kaleschke5Helmut Baumgartner6Gerhard-Paul Diller7Astrid Lammers8Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, GermanyInstitute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, GermanyInstitute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, GermanyDepartment of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, GermanyDepartment of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, GermanyBackground: Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The aim of this study was to analyse the frequency and outcome of IE in contemporary CHD patients based on all IE hospital admissions in Germany over a 10-year period. Methods: Based on data of all hospital admissions in Germany from 2009 to 2018, we identified all CHD cases with a diagnosis of IE. The data contained information on patient demographics, diagnoses, surgical procedures, and mortality. The primary endpoint of the study was endocarditis-associated mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis, renal dialysis, resuscitation, or intubation). Results: Overall, 309,245 CHD inpatient cases were included in the analysis (underlying heart defects of simple complexity 55%, moderate complexity 23%, and complex heart defects 22%, respectively). Of those, 2512 (0.8% of all inpatient cases) were treated for IE. The mortality rate of IE inpatient cases was 6% with a major adverse events rate of 46%, and 41.5% of cases required surgical intervention. The overall IE associated mortality was lower in adult CHD cases compared to the 153,242 in adult IE cases without CHD (7.1% vs. 16.1%, <i>p</i> < 0.001). After adjustments using multivariable logistic regression analysis, the presence or complexity of CHD was not associated with the outcomes. Meanwhile, age, male sex, and co-morbidities emerged as significant predictors of adverse outcomes. Conclusions: IE accounts for a minority of CHD related hospitalizations but remains a deadly disease, and major adverse events are common in this setting. Due to different demographic and co-morbidity spectrums, adult CHD patients tend to have better survival prospects when compared to non-CHD IE patients. Acquired co-morbidities emerged as the main predictors of adverse outcomes.https://www.mdpi.com/2077-0383/10/21/5071congenital heart diseaseinfective endocarditisoutcomesmortality |
| spellingShingle | Maarja Maser Eva Freisinger Leo Bronstein Jeanette Köppe Stefan Orwat Gerrit Kaleschke Helmut Baumgartner Gerhard-Paul Diller Astrid Lammers Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases Journal of Clinical Medicine congenital heart disease infective endocarditis outcomes mortality |
| title | Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases |
| title_full | Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases |
| title_fullStr | Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases |
| title_full_unstemmed | Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases |
| title_short | Frequency, Mortality, and Predictors of Adverse Outcomes for Endocarditis in Patients with Congenital Heart Disease: Results of a Nationwide Analysis including 2512 Endocarditis Cases |
| title_sort | frequency mortality and predictors of adverse outcomes for endocarditis in patients with congenital heart disease results of a nationwide analysis including 2512 endocarditis cases |
| topic | congenital heart disease infective endocarditis outcomes mortality |
| url | https://www.mdpi.com/2077-0383/10/21/5071 |
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