Table 1.
Characteristics of Study Cohort
| Overall Cohort | Patients Treated Medically | Patients Treated Surgically | P | |
|---|---|---|---|---|
| Baseline patient features | ||||
| Age, y | 66.2 ± 13.2 | 63.4 ± 14.8 | 66.7 ± 12.9 | 0.42 |
| Male sex | 45/71 (63%) | 8/12 (67%) | 37/59 (63%) | 0.80 |
| Hypertension | 48/71 (68%) | 8/12 (67%) | 40/59 (68%) | 0.94 |
| Diabetes mellitus | 26/71 (37%) | 3/12 (25%) | 23/59 (39%) | 0.36 |
| Diabetes subtype | 0.11 | |||
| Diet only | 7/26 (27%) | 0/7 | 7/7 (100%) | |
| Oral medication | 4/26 (15%) | 2/4 (50%) | 2/4 (50%) | |
| Insulin requiring | 15/26 (58%) | 1/15 (7%) | 14/15 (93%) | |
| Body mass index, kg/m2 | 27.1 ± 6.2 | 27.2 ± 7.4 | 27.1 ± 5.9 | 0.96 |
| Coronary artery disease | 21/71 (30%) | 1/12 (8%) | 20/59 (34%) | 0.08 |
| Previous endocarditis | 1/71 (1%) | 0/12 | 1/59 (2%) | 0.65 |
| History of fever | 50/71 (70%) | 9/12 (75%) | 41/59 (70%) | 0.70 |
| Predisposing heart condition | 53/71 (75%) | 8/12 (67%) | 47/59 (80%) | 0.33 |
| Injection drug use | 2/71 (3%) | 1/12 (8%) | 1/59 (2%) | 0.21 |
| Previous heart surgery | 5/71 (7%) | 0/12 | 5/59 (9%) | 0.30 |
| Logistic EuroSCOREa | 16.9 ± 12.4 | 11.4 ± 7.0 | 18.1 ± 13.0 | 0.02 |
| Glomerular filtration rate (mL/min/1.73 m2)b | 82 ± 46 | 114 ± 48 | 76 ± 43 | 0.01 |
| Hemoglobin, mmol/L | 6.6 ± 1.2 | 6.7 ± 0.8 | 6.5 ± 1.3 | 0.65 |
| White blood cell count, Gpt/L | 11.4 ± 6.3 | 7.1 ± 2.7 | 12.2 ± 6.5 | 0.009 |
| C‐reactive protein, mg/L | 84 ± 87 | 30 ± 17 | 99 ± 92 | <0.001 |
| Medication on admission | ||||
| Antiplatelet agent | 14/71 (20%) | 3/12 (25%) | 11/59 (19%) | 0.61 |
| Oral anticoagulant | 2/71 (3%) | 0/12 | 2/59 (3%) | 0.52 |
| Statin | 11/71 (16%) | 2/12 (17%) | 9/59 (15%) | 0.90 |
| β‐Blocker | 21/71 (30%) | 5/12 (42%) | 16/59 (27%) | 0.31 |
| Inhibitor of renin angiotensin system | 32/71 (45%) | 6/12 (50%) | 26/59 (44%) | 0.71 |
| Mental status on admission | 0.12 | |||
| Alert | 55/71 (78%) | 12/12 (100%) | 43/59 (73%) | |
| Lethargic, somnolent or disoriented | 13/71 (18%) | 0 | 13/59 (22%) | |
| Comatose | 3/71 (4%) | 0 | 3/59 (5%) | |
| Chronic illnessc | 44/71 (62%) | 5/12 (42%) | 39/59 (66%) | 0.11 |
| Charlson Comorbidity Indexd | 1.4 ± 1.3 | 1.0 ± 1.4 | 1.4 ± 1.3 | 0.32 |
| Symptom onset to first medical contact, d | 14 ± 35 | 9 ± 10 | 15 ± 38 | 0.56 |
| Transfer from another medical facility | 66/71 (93%) | 10/12 (83%) | 56/59 (95%) | 0.15 |
| Microorganisms and antibiotic therapy | ||||
| Microorganisms in blood cultures | 0.19 | |||
| Staphylococcus aureus | 19/69 (28%) | 1/12 (8%) | 18/57 (32%) | |
| Sensitive | 17/69 (25%) | 0 | 17/57 (30%) | |
| Methicillin‐resistant | 2/69 (3%) | 1/12 (8%) | 1/57 (2%) | |
| Viridans streptococci | 11/69 (16%) | 4/12 (33%) | 7/57 (12%) | |
| Enterococcus species | 11/69 (16%) | 4/12 (33%) | 7/57 (12%) | |
| Streptococcus bovis | 8/69 (11%) | 1/12 (8%) | 7/57 (12%) | |
| Coagulase‐negative staphylococci | 5/69 (7%) | 1/12 (8%) | 4/57 (7%) | |
| Mixed infection | 2/69 (3%) | 0 | 2/57 (4%) | |
| Other | 7/69 (10%) | 1/12 (8%) | 6/57 (11%) | |
| Blood culture negative | 6/69 (9%) | 0 | 6/57 (11%) | |
| Symptom onset to initiation of antibiotic therapy, d | 25 ± 44 | 22 ± 16 | 26 ± 48 | 0.76 |
| Echocardiography and computed tomography | ||||
| Affected valve | 0.34 | |||
| Mitral | 43/71 (60%) | 8/12 (67%) | 35/59 (59%) | |
| Aortic | 19/71 (27%) | 4/12 (33%) | 15/59 (25%) | |
| Both | 9/71 (13%) | 0/12 | 9/59 (15%) | |
| No. of vegetations | 1.4 ± 0.6 | 1.6 ± 0.7 | 1.4 ± 0.5 | 0.27 |
| Maximum length of vegetation(s), mm | 17 ± 5 | 14 ± 4 | 18 ± 6 | 0.03 |
| Mobile vegetation | 64/68 (94%) | 11/12 (92%) | 53/56 (95%) | 0.69 |
| Valvular regurgitation | 0.80 | |||
| None | 4/71 (6%) | 1/12 (8%) | 3/56 (5%) | |
| Mild | 32/67 (48%) | 6/12 (50%) | 26/56 (44%) | |
| Moderate | 35/67 (52%) | 5/12 (42%) | 30/56 (51%) | |
| Left ventricular ejection fraction, % | 62 ± 8 | 65 ± 8 | 61 ± 8 | 0.17 |
| Computed tomography on admission | 66/71 (93%) | 8/12 (67%) | 58/59 (98%) | <0.001 |
| Surgery | ||||
| Type of surgery | ||||
| Valve replacement (biological) | NA | NA | 43/59 (73%) | NA |
| Valve replacement (mechanical) | NA | NA | 9/59 (15%) | NA |
| Reconstruction | NA | NA | 5/59 (8%) | NA |
| Both biological and mechanical valve replacement | NA | NA | 1/59 (2%) | NA |
| Both valve replacement and reconstruction | NA | NA | 1/59 (2%) | NA |
| Time between symptom onset and surgery, d | NA | NA | 31 ± 48 | NA |
| Time between first medical contact and surgery, d | NA | NA | 16 ± 31 | NA |
Abbreviations: Gpt, giga (109) particles; NA, not applicable.
Continuous data are presented as means and standard deviations.
a
The logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) is a scoring system used to predict mortality from cardiac surgery with increasing values indicating a higher risk.17
b
Estimated according to modification of diet in renal disease study.18
c
Defined as the presence of chronic comorbidities such as diabetes mellitus, cancer, immunosuppression, hemodialysis, chronic obstructive pulmonary disease, and cirrhosis.
d
The Charlson Comorbidity Index is a scoring system to predict mortality with increasing values indicating a higher risk.19