Clinical predictors of adverse outcomes in patients with infective endocarditis undergoing surgery: a retrospective analysis

Introduction
Infective endocarditis (IE) remains a challenging condition with high mortality despite advances in diagnostics and treatment. This study aimed to assess clinical, laboratory, and microbiological predictors of early postoperative complications in patients undergoing surgery for IE.

Material and methods
Medical records of consecutive adult patients with confirmed IE requiring cardiac surgery treated surgically between 2017 and 2018 were retrospectively analysed, including preoperative clinical profile, complications and up to 1-year mortality (based on hospital records from the outpatient clinic).

Results
The cohort (N = 31) was predominantly male (66%) with a mean age of 55 years and a high prevalence of comorbidities including hypertension, chronic kidney disease (CKD), and diabetes mellitus. Staphylococcus aureus was the most frequently identified pathogen. Major postoperative complications were common and included new-onset atrial fibrillation (58%), acute kidney injury (AKI), bleeding, cardiac tamponade, and conduction disturbances requiring permanent pacemaker implantation. Predictors of mortality included CKD, elevated creatinine, lower glomerular filtration rate, staphylococcal infection, and higher EuroSCORE II. AKI was significantly associated with male gender, diabetes, and elevated NT-proBNP. Bleeding and cardiac tamponade were more frequent in patients with older age, renal dysfunction, anaemia, and higher surgical risk. De novo atrial fibrillation was more common in patients with older age and pre-existing coronary artery disease. Conduction disturbances were significantly more frequent in patients with prior cardiac surgery, alcohol dependence, and structural valve complications.

Conclusions
These findings underscore the importance of identifying high-risk patients using clinical, laboratory, and echocardiographic parameters to guide perioperative management and improve outcomes in surgical IE.