Incidence and predictive factors of mortality of infective endocarditis in adults with congenital heart disease: A systematic review and meta-analysis.

ABSTRACT

INTRODUCTION: Congenital heart diseases (CHD) with abnormal turbulent blood flow are associated with the highest risk of infective endocarditis (IE). Despite advancement in diagnostics and treatment, the mortality rate of IE remains high due the life-threatening complications. Our study aims to assess the incidence and mortality rates of IE and predictive factors for mortality among adults CHD (ACHD). METHODS: A systematic literature search was conducted on PubMed, SCOPUS, and Ovid SP to retrieve relevant studies. The pooled estimates and predictors of mortality were calculated using the random-effects generic inverse variance method using R programming. RESULTS: 12 studies involving 3738 ACHD patients were included in this meta-analysis. The overall incidence of IE in ACHD was 1.26 per 1000 patient-years (95% CI 0.55-1.96). 60% (95% CI 46-72%) of patients had surgical management for IE. The mortality rate of IE was 9% (95% CI 7-12%). The predictors of mortality were conservative management (OR 5.07, 95% CI 4.63-5.57), renal dysfunction (OR 4.15, 95% CI 2.92-5.88), cerebral complications (OR 3.59, 95% CI 1.78-7.23), abscesses/valve complications (OR 2.67, 95% CI 1.71-4.16), Staphylococcus aureus infection (OR 2.32, 95% CI 1.33-4.06), emboli (OR 2.03, 95% CI 1.47-2.79), body mass index (OR 1.10, 95% CI 1.01-1.21), age (OR 1.02, 95% CI 1.00-1.04), and previous IE (OR 1.02, 95% CI 1.00-1.04). CONCLUSION: The mortality rate of IE in ACHD is low. However, conservative management is associated with the highest risk of mortality.