Surgical and medical management of infective endocarditis in a large tertiary referral center: Clinical characteristics, microbiological profile, and predictors of in-hospital mortality

Aim: Real-world data from large tertiary referral centers reflecting the full spectrum of disease complexity remain limited. We aimed to characterize the clinical profile, microbiological landscape, and independent predictors of in-hospital mortality in a consecutive cohort of infective endocarditis (IE) patients managed under a guideline-directed multidisciplinary framework.

Materials and Methods: We retrospectively analyzed 156 patients diagnosed with IE at a tertiary referral center in Türkiye between March 2019 and March 2024. Patients were managed according to the European Society of Cardiology (ESC) guidelines in effect at the time of treatment, with adherence retrospectively assessed against the 2023 ESC criteria by a multidisciplinary endocarditis team. Independent predictors of in-hospital mortality were identified using multivariate logistic regression.

Results: Median age was 61 years (IQR 49 – 67); 71.8% were male and 76.3% had native valve IE. Surgery was performed in 58 patients (37.2%) and medical treatment alone in 98 (62.8%). Blood cultures were negative in 38.5%, and MRSA was the most common organism (21.2%). In-hospital mortality was 15.4%, comparable between surgical (15.5%) and medical (15.3%) groups (p = 1.000). Six variables independently predicted mortality: vasopressor/inotrope requirement (OR 35.87; 95% CI 7.18 – 179), perivalvular abscess (OR 16.79; 1.39 – 202), enterococcal infection (OR 11.43; 1.31 – 99.6), elevated lactate (OR 4.74; 1.87 – 12.0), previous cardiac surgery (OR 5.55; 1.09 – 28.2), and low albumin (OR 0.27 per 10 g/L; 0.08 – 0.95). Apparent discrimination was excellent (AUC = 0.957).

Conclusion: In this real-world IE cohort, hemodynamic instability at presentation was the dominant mortality predictor, while the high culture-negativity rate and MRSA prevalence reflect our transferred-patient profile. Among patients with a surgical indication, surgery was associated with lower mortality, though this is subject to selection bias and confounding by indication. Albumin and lactate are readily available biomarkers warranting prospective evaluation in IE risk stratification.