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28.06.2019 | Review | Ausgabe 6/2019

Infection 6/2019

Prognostic factors of mortality after surgery in infective endocarditis: systematic review and meta-analysis

Infection > Ausgabe 6/2019
Laura Varela Barca, Enrique Navas Elorza, Nuria Fernández-Hidalgo, Jose Luis Moya Mur, Alfonso Muriel García, B. M. Fernández-Felix, Javier Miguelena Hycka, Jorge Rodríguez-Roda, Jose López-Menéndez
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s15010-019-01338-x) contains supplementary material, which is available to authorized users.
The original version of this article was revised: The spelling of the name “Nuria Fernández-Hidalgo” was incorrect.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s15010-019-01357-8.



There is a lack of consensus about which endocarditis-specific preoperative characteristics have an actual impact over postoperative mortality. Our objective was the identification and quantification of these factors.


We performed a systematic review of all the studies which reported factors related to in-hospital mortality after surgery for acute infective endocarditis, conducted according to PRISMA recommendations. A search string was constructed and applied on three different databases. Two investigators independently reviewed the retrieved references. Quality assessment was performed for identification of potential biases. All the variables that were included in at least two validated risk scores were meta-analyzed independently, and the pooled estimates were expressed as odds ratios (OR) with their confidence intervals (CI).


The final sample consisted on 16 studies, comprising a total of 7484 patients. The overall pooled OR were statistically significant (p < 0.05) for: age (OR 1.03, 95% CI 1.00–1.05), female sex (OR 1.56, 95% CI 1.35–1.81), urgent or emergency surgery (OR 2.39 95% CI 1.91–3.00), previous cardiac surgery (OR 2.19, 95% CI 1.84–2.61), NYHA ≥ III (OR 1.84, 95% CI 1.33–2.55), cardiogenic shock (OR 4.15, 95% CI 3.06–5.64), prosthetic valve (OR 1.98, 95% CI 1.68–2.33), multivalvular affection (OR 1.35, 95% CI 1.01–1.82), renal failure (OR 2.57, 95% CI 2.15–3.06), paravalvular abscess (OR 2.39, 95% CI 1.77–3.22) and S. aureus infection (OR 2.27, 95% CI 1.89–2.73).


After a systematic review, we identified 11 preoperative factors related to an increased postoperative mortality. The meta-analysis of each of these factors showed a significant association with an increased in-hospital mortality after surgery for active infective endocarditis.

Graphic abstract

Graph summary of the Pooled Odds Ratios of the 11 preoperative factors analyzed after the systematic review and meta-analysis.

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