Endocarditis-TR: diagnosis, treatment and prognosis of the infective endocarditis patients admitting tertiary centers of Turkey

Abstract Background/Aim Infective endocarditis (IE) is still a significant cause of morbidity and mortality among cardiovascular diseases. ENDOCARDITIS-TR study aims to evaluate the compliance of the diagnostic and therapeutic methods being used in Turkey with current guidelines. Material and methods The ENDOCARDITIS-TR trial is a multi-centre, prospective, observational study consisting of patients admitted to tertiary centres with a definite diagnose of IE. In addition to the demographic, clinical, microbiological and echocardiographic findings of the patients, adverse events, indications for surgery, and in-hospital mortality were recorded during a 2-year time interval. Results A total of 208 IE patients from 7 tertiary centres in Turkey were enrolled in the study. The study population included 125 (60.1%) native valve IE (NVE), 65 (31.3%) prosthetic IE (PVIE), and 18 (8.7%) intracardiac device-related IE (CDRIE). One hundred thirty-five patients (64.9%) were culture positive, and the most frequent pathogenic agent was methicillin-susceptible Staphylococcus aureus (MSSA) (18.3%). Among 155 (74.5%) patients with an indication for surgery, only 87 (56.1%) patients underwent surgery. The all-cause mortality rate was 29.3% in-hospital follow-up. Multivariable Cox regression analysis revealed that absence of surgery when indicated (HR: 3.29, 95% CI: 0.93–11.64, p=0.05), albumin level at admission (HR: 0.46 95%, CI: 0.29–0.73, p<0.01), abscess formation (HR: 2.11, 95% CI: 1.01–4.38, p=0.04) and systemic embolism (HR: 1.78, 95% CI: 1.05–3.02, p=0.03) were ascertained as independent predictors of in-hospital all-cause mortality. Conclusion The short term results of the ENDOCARDITIS-TR trial showed the high frequency of staphylococcal IE, relatively high in-hospital mortality rates, shortage of surgical treatment despite guideline-based surgical indications and low usage of novel imaging techniques. The results of this study will provide a better insight to physicians in respect to their adherence to clinical practice guidelines. Funding Acknowledgement Type of funding sources: None.