Time interval between infective endocarditis first symptoms and diagnosis: relationship to infective endocarditis characteristics, microorganisms and prognosis.

Yohan N’guyen (1) , Xavier Duval (2) , Matthieu Revest (3) , Matthieu Saada (4) , Marie-Line Erpelding (5, 6) , Christine Selton-Suty (7) , Coralie Bouchiat (8) , François Delahaye (9, 10) , Catherine Chirouze (11) , François Alla (12, 13, 5) , Christophe Strady (14) , Bruno Hoen (15, 16)

1 Service de médecine interne [CHU Reims]
2 CIC Hôpital Bichat
3 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
4 Service des maladies infectieuses et tropicales [CH Perpignan 20]
5 CIC-EC - Centre d'investigation clinique - Epidémiologie clinique [Nancy]
6 Pôle S2R - Service d'Epidémiologie et Evaluations Cliniques [CHRU Nancy]
7 Service de Cardiologie [CHRU Nancy]
8 Centre National de Reference des Staphylocoques
9 Hôpital Louis Pradel [CHU - HCL]
10 UCBL - Université Claude Bernard Lyon 1
11 LCE - Laboratoire Chrono-environnement (UMR 6249)
12 CIC-IT - Centre d'Investigation Clinique - Innovation Technologique [Nancy]
13 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
14 Polyclinique Saint André
15 CIC - Antilles Guyane - Centre d'Investigation Clinique Antilles-Guyane
16 UA UFR SM - Université des Antilles - UFR des sciences médicales Hyacinthe Bastaraud

OBJECTIVE: To analyze the characteristics and outcome of infective endocarditis (IE) according to the time interval between IE first symptoms and diagnosis. METHODS: Among the IE cases of a French population-based epidemiological survey, patients having early-diagnosed IE (diagnosis of IE within 1 month of first symptoms) were compared with those having late-diagnosed IE (diagnosis of IE more than 1 month after first symptoms). RESULTS: Among the 486 definite-IE, 124 (25%) had late-diagnosed IE whereas others had early-diagnosed IE. Early-diagnosed IE were independently associated with female gender (OR = 1.8; 95% CI [1.0-3.0]), prosthetic valve (OR= 2.6; 95% CI [1.4-5.0]) and staphylococci as causative pathogen (OR = 3.7; 95% CI [2.2-6.2]). Cardiac surgery theoretical indication rates were not different between early and late-diagnosed IE (56.3% vs 58.9%), whereas valve surgery performance was lower in early-diagnosed IE (41% vs 53%; p = .03). In-hospital mortality rates were higher in early-diagnosed IE than in late-diagnosed IE (25.1% vs 16.1%; p < .001). CONCLUSIONS: The time interval between IE first symptoms and diagnosis is closely related to the IE clinical presentation, patient characteristics and causative microorganism. Better prognosis reported in late-diagnosed IE may be related to a higher rate of valvular surgery. KEY MESSAGES Infective endocarditis, which time interval between first symptoms and diagnosis was less than one month, were mainly due to Staphylococcus aureus in France. Staphylococcus aureus infective endocarditis were associated with septic shock, transient ischemic attack or stroke and higher mortality rates than infective endocarditis due to other bacteria or infective endocarditis, which time interval between first symptoms and diagnosis was more than one month. Infective endocarditis, which time interval between first symptoms and diagnosis was more than one month, were accounting for one quarter of all infective endocarditis in our study and were associated with vertebral osteomyelitis and a higher rate of cardiac surgery performed for hemodynamic indication than other infective endocarditis.

Mots clés: cardiac surgery; acute; Infective endocarditis; chronic; mortality; prognosis; septic shock; stroke

Domaines: Médecine humaine et pathologie

Yohan N’guyen, Xavier Duval, Matthieu Revest, Matthieu Saada, Marie-Line Erpelding, et al.. Time interval between infective endocarditis first symptoms and diagnosis: relationship to infective endocarditis characteristics, microorganisms and prognosis.. Annals of Medicine, 2017, 49 (2), pp.117-125. ⟨10.1080/07853890.2016.1235282⟩. ⟨hal-01509563⟩