Objective Infective endocarditis (IE) remains a life-threatening infectious disease characterized by high morbidity and mortality despite substantial advances in diagnostic and therapeutic strategies (Eur Heart J 44:3948–4042, 2023, Eur J Clin Microbiol Infect Dis 44:1325–1333, 2025). Patients requiring intensive care unit (ICU) admission represent the most severe clinical spectrum of IE and continue to exhibit markedly elevated mortality rates (Klimik Derg 32:2–116, Klimik Derg 36:216–225, 2023). Early identification of mortality predictors in critically ill patients is essential for optimizing multidisciplinary management strategies and improving clinical outcomes (Eur Heart J 44:3948–4042, 2023, Open Forum Infect Dis 12:ofaf628, 2025). The aim of this study was to evaluate clinical and laboratory predictors of mortality among patients with infective endocarditis managed in the intensive care unit of a tertiary care center. Methods This retrospective cohort study included 59 adult patients with infective endocarditis who were managed in the intensive care unit of Ankara Bilkent City Hospital between 2022 and 2025. Demographic characteristics, comorbidities, microbiological findings, clinical severity scores, and laboratory parameters obtained at ICU admission were analyzed. The primary outcome was defined as in-ICU mortality. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the predictive performance of the APACHE II score and the GCS. The AUCs of APACHE II and GCS were compared using DeLong’s test for correlated ROC curves. Independent predictors of mortality were identified using multivariable logistic regression analysis. Time-to-event analysis was conducted using a Cox proportional hazards regression model to evaluate factors associated with mortality during ICU follow-up. Internal validation of the logistic regression and Cox proportional hazards models was performed using bootstrap resampling (10000 iterations). Results The mean age of the cohort was 62.3 ± 19.0 years. The overall in-ICU mortality rate was 52.5% (n = 31). ROC analysis demonstrated that the Glasgow Coma Scale showed a numerically higher discriminative performance compared with the APACHE II score (AUC: 0.758 vs. 0.717); however, the difference was not statistically significant. Multivariable logistic regression analysis identified lower GCS score (OR = 0.75, p = 0.017), presence of coronary artery disease (OR = 11.23, p = 0.008), fungal etiology (OR = 38.96, p = 0.008), and higher Nutritional Risk Screening (NRS) score (OR = 1.90, p = 0.043) as independent predictors of in-ICU mortality (Heart Fail Rev 30:1377–1395, 2025, Expert Consensus on the Prevention of Secondary Mucormycosis Following Respiratory Viral Infections, 2026). In Cox proportional hazards analysis, septic embolism (HR = 6.58, p = 0.047), coronary artery disease (HR = 3.23, p = 0.007), elevated total bilirubin (HR = 2.58, p = 0.006), increased creatinine (HR = 1.48, p = 0.006), elevated lactate dehydrogenase (HR = 1.001, p = 0.030), and lower albumin levels (HR = 0.92, p = 0.039) were independently associated with increased mortality hazard during ICU follow-up (Klimik Derg 32:2–116, 2020, Heart Fail Rev 30:1377–1395, 2025). Conclusion Mortality among critically ill patients with infective endocarditis remains substantially high despite contemporary management strategies (Eur Heart J 44:3948–4042, 2023, Eur J Clin Microbiol Infect Dis 44:1325–1333, 2025). Neurological status assessed by GCS, nutritional risk evaluated by NRS, fungal etiology, and coronary artery disease emerged as key determinants of mortality risk, while septic embolism and markers of multiorgan dysfunction influenced mortality over time (Heart Fail Rev 30:1377–1395, 2025, Expert Consensus on the Prevention of Secondary Mucormycosis Following Respiratory Viral Infections, 2026). These findings highlight the importance of early risk stratification and multidisciplinary management and support the development of ICU-specific prognostic models to improve outcomes in this high-risk population (Eur Heart J 40:3222–3232, 2019, Open Forum Infect Dis 12:ofaf628, 2025). Clinical trial number Not applicable.

ICU-specific determinants of mortality in critically ill patients with infective endocarditis

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2026年5月19日

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Dilek Kuzukiran Kocatas,
Behiye Deniz Kosovali,
Nevzat Mehmet Mutlu,
Gunal Bilek

摘要

Objective

Infective endocarditis (IE) remains a life-threatening infectious disease characterized by high morbidity and mortality despite substantial advances in diagnostic and therapeutic strategies (Eur Heart J 44:3948–4042, 2023, Eur J Clin Microbiol Infect Dis 44:1325–1333, 2025). Patients requiring intensive care unit (ICU) admission represent the most severe clinical spectrum of IE and continue to exhibit markedly elevated mortality rates (Klimik Derg 32:2–116, Klimik Derg 36:216–225, 2023). Early identification of mortality predictors in critically ill patients is essential for optimizing multidisciplinary management strategies and improving clinical outcomes (Eur Heart J 44:3948–4042, 2023, Open Forum Infect Dis 12:ofaf628, 2025). The aim of this study was to evaluate clinical and laboratory predictors of mortality among patients with infective endocarditis managed in the intensive care unit of a tertiary care center.

Methods

This retrospective cohort study included 59 adult patients with infective endocarditis who were managed in the intensive care unit of Ankara Bilkent City Hospital between 2022 and 2025. Demographic characteristics, comorbidities, microbiological findings, clinical severity scores, and laboratory parameters obtained at ICU admission were analyzed. The primary outcome was defined as in-ICU mortality. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the predictive performance of the APACHE II score and the GCS. The AUCs of APACHE II and GCS were compared using DeLong’s test for correlated ROC curves. Independent predictors of mortality were identified using multivariable logistic regression analysis. Time-to-event analysis was conducted using a Cox proportional hazards regression model to evaluate factors associated with mortality during ICU follow-up. Internal validation of the logistic regression and Cox proportional hazards models was performed using bootstrap resampling (10000 iterations).

Results

The mean age of the cohort was 62.3 ± 19.0 years. The overall in-ICU mortality rate was 52.5% (n = 31). ROC analysis demonstrated that the Glasgow Coma Scale showed a numerically higher discriminative performance compared with the APACHE II score (AUC: 0.758 vs. 0.717); however, the difference was not statistically significant. Multivariable logistic regression analysis identified lower GCS score (OR = 0.75, p = 0.017), presence of coronary artery disease (OR = 11.23, p = 0.008), fungal etiology (OR = 38.96, p = 0.008), and higher Nutritional Risk Screening (NRS) score (OR = 1.90, p = 0.043) as independent predictors of in-ICU mortality (Heart Fail Rev 30:1377–1395, 2025, Expert Consensus on the Prevention of Secondary Mucormycosis Following Respiratory Viral Infections, 2026). In Cox proportional hazards analysis, septic embolism (HR = 6.58, p = 0.047), coronary artery disease (HR = 3.23, p = 0.007), elevated total bilirubin (HR = 2.58, p = 0.006), increased creatinine (HR = 1.48, p = 0.006), elevated lactate dehydrogenase (HR = 1.001, p = 0.030), and lower albumin levels (HR = 0.92, p = 0.039) were independently associated with increased mortality hazard during ICU follow-up (Klimik Derg 32:2–116, 2020, Heart Fail Rev 30:1377–1395, 2025).

Conclusion

Mortality among critically ill patients with infective endocarditis remains substantially high despite contemporary management strategies (Eur Heart J 44:3948–4042, 2023, Eur J Clin Microbiol Infect Dis 44:1325–1333, 2025). Neurological status assessed by GCS, nutritional risk evaluated by NRS, fungal etiology, and coronary artery disease emerged as key determinants of mortality risk, while septic embolism and markers of multiorgan dysfunction influenced mortality over time (Heart Fail Rev 30:1377–1395, 2025, Expert Consensus on the Prevention of Secondary Mucormycosis Following Respiratory Viral Infections, 2026). These findings highlight the importance of early risk stratification and multidisciplinary management and support the development of ICU-specific prognostic models to improve outcomes in this high-risk population (Eur Heart J 40:3222–3232, 2019, Open Forum Infect Dis 12:ofaf628, 2025).

Clinical trial number

Not applicable.