Awais Farhad1, Ainan Arshad1, Sara Salim Ali2, Ahmed Ayaz1

1Aga Khan University Hospital, Karachi, Pakistan, 2University of Texas medical branch, Galveston, Texas, Pakistan

Despite advances in cardiac imaging, medical therapy, and surgical techniques, in-hospital mortality of infective endocarditis is high and has remained unchanged over the past two decades. The continuous change in the disease’s clinical profile and a limited number of studies in low-middle-income countries demands extensive research to generate local evidence. We aimed to study the clinical characteristics, causative agents, and outcomes of Infective Endocarditis (IE) patients admitted in a tertiary care hospital of a low-middle income country.

This retrospective cohort study included all adult patients admitted in the Aga Khan University Hospital with the diagnosis of infective endocarditis from 2008 to 2018. We identified these cases using electronically coded medical records (International Classification of Diseases 9th revision with clinical modification, or ICD-9-CM). Statistical analysis was performed using IBM SPSS 22, continuous variables were reported as mean ± SD, and categorical variables were reported as counts and percentages. Cox regression analysis was done to evaluate the outcomes of infective endocarditis.

We identified 245 cases of infective endocarditis, out of which 144 (58.8%) were male, and the mean age was 47.2 years. Diabetes, Hypertension, and previous history of ischemic heart disease were the most common comorbid conditions. Blood cultures were positive in 38% of the cases, with staphylococci (53%) being the most common causative agent followed by streptococci (18.2%). Of all the patients, 20.8% required surgical repair, and the overall in-hospital mortality rate was 16% at a mean length of stay of 9.9 ± 9.2 days. Previous history of ischemic heart disease, chronic kidney disease, and stroke were independently associated with increased in-hospital mortality.

Our study found that in-hospital mortality of infective endocarditis is comparable to high-income countries. Patients having a history of ischemic heart disease, chronic kidney disease, and stroke should be managed as high-risk patients