Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study

Authors: Gilbert Habib, Paola Anna Erba, Bernard Iung, Erwan Donal, Bernard Cosyns, Cécile Laroche, Bogdan A. Popescu, Bernard Prendergast, Pilar Tornos, Anita Sadeghpour, Léopold Oliver, Jolanta-Justina Vaškelytė, Rouguiatou Sow, Olivier Axler, Aldo P. Maggioni, Patrizio Lancellotti, EURO-ENDO Investigators, Chris P Gale, B. Beleslin, Andrzej Budaj, Ovidiu Chioncel, Nikolaos Dagres, Nicolas Danchin, Jonathan Emberson, David Erlinge, Michael Glikson, Adam Gray, M Kayikcioglu, Aldo P. Maggioni, V K Nagy, А. О. Недошивин, A-S Petronio, Jolien W. Roos‐Hesselink, Lars Wallentin, Uwe Zeymer, Gilbert Habib, Patrizio Lancellotti, B Cosyns, Erwan Donal, Paola Anna Erba, Bernard Iung, Aldo P. Maggioni, Bogdan A. Popescu, B Prendergast, P. Tornos, Maryna Andarala, C Berle, A Brunel-Lebecq, E Fiorucci, C Laroche, V. Missiamenou, Clare Taylor, Nora Nabila Ali Tatar-Chentir, Mouaz H. Al‐Mallah, Meriam Åström Aneq, George Athanassopoulos, Luigi P. Badano, S. Benyoussef, Erick Calderón-Aranda, Nuno Cardim, KL Chan, B Cosyns, Isabel Cruz, Thor Edvardsen, Georg Goliasch, Gilbert Habib, Andreas Hagendorff, Krasimira Hristová, Bernard Iung, Otto Kamp, D-H Kang, William Kong, С.Т. Мацкеплишвили, Marwa Meshaal, M Mirocevic, Aleksandar Nešković, Michal Pazderník, E Plonska-Gosciniak, Bogdan A. Popescu, B Prendergast, Maha Raissouni, Ricardo Ronderos, L E Sade, Anita Sadeghpour, Antonia Sambola, Shantanu P. Sengupta, J Separovic-Hanzevacki, Masami Takeuchi, Edwin S. Tucay, Ana Clara Tude Rodrigues, Andréa Varga, J. Vaskelyte, Kazufumi Yamagata, K Yiangou, H Zaky, Isabel Granada, M Mahia, S Ressi, Francisco Nacinovich, Ana Iribarren, P. Fernandez Oses, Gustavo Avegliano, Eduardo Filipini, R Obregon, M Bangher, J Dho, Luis R Cartasegna, M. Plastino, V Novas, C Shigel, Graciela Reyes, M De Santos, Natalio Gastaldello, M Granillo Fernandez, M Potito, Gisela Streitenberger, P Velazco, José Casabé, Claudia Cortés, Eduardo Guevara, Fabián Salmo, M Seijo, F Weidinger, Maria Heger, Renee L. Brooks, Claudia Stöllberger, Carolyn Y. Ho, Leonard Perschy, L Puskas, Christian Binder, Raphaël Rosenhek, M Schneider, M-P Winter, E Hoffer, M Melissopoulou, E Lecoq, D. Legrand, Sandrine Jacquet, M Massoz, Luc Piérard, Stella Marchetta, Raluca Dulgheru, C D ́ Emal, Cécile Oury, Steven Droogmans, D. Kerkhove, D. Plein, L Soens, Caroline Weytjens, Andreea Motoc, Bram Roosens, I Lemoine, Inez Rodrigus, Bernard P. Paelinck, Bram J. Amsel, Philippe Unger, Déborah Konopnicki, C. Beauloye, Agnès Pasquet, Jean‐Louis Vanoverschelde, S Pierard, David Vancraeynest, F Sinnaeve, José Lázaro Andrade, Kamila Fernanda Staszko, R Dos Santos Monteiro, Marcelo Haertel Miglioranza, D L Shuha, M Alcantara, V Cravo, L Fazzio, Ana Félix, M Iso, C Musa, Ana Paula dos Reis Velloso Siciliano, Fábio Villaça Guimarães Filho, Ana Clara Tude Rodrigues, F Vilela, Juarez R. Braga, R Silva, Daniela Laranja Gomes Rodrigues, L Silva, Samira Saady Morhy, Cláudio Henrique Fischer, R Silva, Marcelo Luiz Campos Vieira, T Afonso, J. Abreu, Sandra Nívea dos Reis Saraiva Falcão, Valdir Ambrósio Moisés, Agostinho Pinto Gouvêa, Frederico Mancuso, Ana Carolina Mello Fontoura de Souza, C Y Silva, G João, Cely Saad Abboud, Rodrigo Bellio de Mattos Barretto, A Ramos, Renato Tambellini Arnoni, Jorge Eduardo Assef, Dorival Júlio Della Togna, David Le Bihan, L. Miglioli, A P Romero Oliveira, Roberto Tadeu Magro Kroll, Daniel Cortez, Cláudio Léo Gelape, M d C Peirira Nunes, Teresa Cristina Abreu Ferrari, Kevin A. Hay, V. Le, Mathieu Page, Frédéric Poulin, Claude Sauvé, Karim Serri, Chantal Mercure, J Beaudoin, Philippe Pîbarot, Igal A. Sebag, Lawrence Rudski, G Ricafort, Bruno Baršić, Vladimir Krajinović, Martina Vargović, Daniel Lovrić, V Reskovic-Luksic, Josip Vincelj, Sandra Jakšić Jurinjak, V Yiannikourides, Marios Ioannides, C Pofaides, V Masoura, Jiří Pudich, Aleš Linhart, Michal Širanec, J Marek, K Blechova, Mirt Kamenik, Radek Pelouch, Zdeněk Coufal, M Mikulica, Martin Gřiva, Eva Jančová, M Mikulcova, Miloš Táborský, Jan Přeček, Markéta Ječmenová, J Látal, J Widimský, T Butta, S Machacek, R Vancata, Jindřich Špinar, Mária Holická, F Pow Chon Long, N Anzules, Arturo Carpio, G Largacha, Ernesto Peñaherrera, Davide Moreira, E Mahfouz, E Elsafty, Amel M. Soliman, Yazan Zayed, J Aboulenein, M Abdel-Hay, Abdallah Almaghraby, Mahmoud Abdelnaby, Mustafa I. Ahmed, Basma Hammad, Yehia Saleh, Hatice S. Zahran, O Elgebaly, Aly M A Saad, Mohammed Ali, A Zeid, Reham El Sharkawy, A Al Kholy, Ramy Doss, Dina Osama, Hussien Rizk, A Elmogy, M Mishriky, Patrick Assayag, Safwane El Hatimi, S. Hubert, J-P Casalta, Frédérique Gouriet, Florent Arregle, Serge Cammilleri, L. Tessonnier, Alberto Ribéri, Élisabeth Botelho-Nevers, Amandine Gagneux‐Brunon, Romain Pierrard, C. Tulane, Saveria Campisi, J-F Fuzellier, M Detoc, T Mehalla, David Boutoille, Anne-Sophie Lecompte, M. Lefèbvre, S. Pattier, Ousama Al Habash, N Asseray-Madani, Charlotte Biron, Julia Brochard, J. Caillon, C Cueff, Thierry Le Tourneau, R. Lecomte, M. Michel, Jéremie Orain, S Delarue, M. Le Bras, J-F Faucher, Victor Aboyans, A Beeharry, H. Durox, Maximiliano Otero Lacoste, Julien Magné, Dania Mohty, Anthony S. David, V. Pradel, Victor Sierra, A. Neykova, B Bettayeb, S Elkentaoui, B. Tzvetkov, Gregory J. Landry, C. Strady, K Ainine, S. Baumard, Camille Brasselet, C Tassigny, V Valente-Pires, Marie‐Paule Lefranc, Bruno Hoen, Benjamin Lefèvre, Elodie Curlier, C Callier, N Fourcade, Yannick Jobic, S Ansard, Rozenn Le Berre, Florent Le Ven, M-C Pouliquen, Gemma Prat, Philippe Roux, F Bouchart, A. Savouré, C. Alarçon, C. Chapuzet, I. Gueït, C. Tribouilloy, Yohann Bohbot, Fanny Peugnet, Mesut Gun, Xavier Duval, X. Lescure, Emila Ilic-Habensus, Nicolas Sadoul, Christine Selton‐Suty, François Alla, François Goehringer, Olivier Huttin, Elodie Chevalier, Rosa García, V. Le Marcis, Pierre Tattevin, Erwan Flécher, Matthieu Revest, C. Chirouze, Kévin Bouiller, Laurent Hustache‐Mathieu, Timothée Klopfenstein, J Moreau, Pierre‐Edouard Fournier, A-S Brunel, Pascal Lim, Léopold Oliver, Julien Ternacle, Amina Moussafeur, P. Chavanet, Lionel Piroth, Arnaud Salmon‐Rousseau, M. Buisson, Sophie Mahy, Carolina Castro Martins, Sandrine Gohier, Olivier Axler, Florian Baumann, S Lebras, C. Piper, Denise Guckel, Jochen Börgermann, Dieter Horstkotte, Eliane Roseli Winkelmann, B Brockmeier, Douglas Grey, Georg Nickenig, Robert Schueler, Cihat Öztürk, Elisabeth Stöhr, Christian W. Hamm, Thomas Walther, Reynaldo André Brandt, A-C Frühauf, Christine Hartung, Clara Hellner, C. Wild, Miriam Becker, Satoshi Hamada, W. Kaestner, Karl Stangl, Fabian Knebel, Gerd Baldenhofer, Anna Brecht, Henryk Dreger, C Isner, Frieder Pfäfflin, Miriam Stegemann, Ralf Zahn, B. Fraiture, Caroline Kilkowski, A-K Karcher, S Klinger, H Tolksdorf, Dimitris Tousoulis, Constadina Aggeli, Skevos Sideris, Erifili Venieri, G. Sarri, Dimitris Tsiapras, I Armenis, A Koutsiari, G Floros, C. Grassos, Stylianos Dragasis, Lοukianos S. Rallidis, Charalampos Varlamos, Lampros K. Michalis, Katerina Κ. Naka, Aris Bechlioulis, Anna Kotsia, Λάμπρος Λάκκας, Κωνσταντίνος Παππάς, Constantinos Papadopoulos, S Kiokas, Athina Lioni, S Misailidou, John Barbetseas, Μaria Bonou, Chris J. Kapelios, I Tomprou, Kanella Zerva, Athanasios Manolis, E. Hamodraka, Dimitrios Athanasiou, G Haralambidis, H Samaras, L Poulimenos, A Nagy, Andrea Bartykowszki, Edit Gara, Kunda Mungulmare, Ravi R. Kasliwal, Manish Bansal, S Ranjan, A Bhan, Majid Kyavar, Majid Maleki, F Noohi Bezanjani, Azin Alizadehasl, Shabnam Boudagh, A Ghavidel, Pardis Moradnejad, Hamid Reza Pasha, Behshid Ghadrdoost, Dan Gilon, Jacob Strahilevitz, Maor Wanounou, Sarah Israel, Carlo D’Agostino, Paolo Colonna, Lucrezia De Michele, F Fumarola, M Stante, N Marchionni, Valentina Scheggi, B Alterini, Stefano Del Pace, Pierluigi Stefàno, Clotilde Sparano, N Ruozi, R Tenaglia, Denisa Muraru, Ugo Limbruno, Alberto Cresti, Pasquale Baratta, Marco Solari, Cristina Giannattasio, Antonella Moreo, Benedetta De Chiara, Beatriz Montero, F Musca, C A Orcese, Francesca Panzeri, F. Spano, Claudio Russo, Ottavio Alfieri, Michele De Bonis, Stefania Chiappetta, Benedetto Del Forno, Marco Ripa, Paolo Scarpellini, Chiara Tassan Din, Barbara Castiglioni, Renée Pasciuta, Silvia Carletti, David Ferrara, Monica Guffanti, Giuseppe Iaci, E Lapenna, Teodora Nisi, Chiara Oltolini, Elena Busnardo, U. Pajoro, Eustachio Agricola, Roberta Meneghin, Davide Schiavi, Federico Piscione, Rodolfo Citro, Rossella Maria Benvenga, Luigi Greco, L Soriente, I Radano, Costantina Prota, Michele Bellino, Davide Di Vece, Francesco Santini, Antonio Salsano, Guido Maria Olivieri, F Turrini, R Messora, Stefano Tondi, Andreea Olaru, Virginia Agnoletto, L Grassi, Claudia Leonardi, S Sansoni, Stefano del Ponte, Guglielmo Mario Actis Dato, Andrea De Martino, Nobuyuki Ohte, Shohei Kikuchi, Kazuaki Wakami, Kazutaka Aonuma, Yu Bin Seo, Tomoko Ishizu, Tomoko Machino‐Ohtsuka, Masae Yamamoto, N Iida, Hiromichi Nakajima, Yu Nakagawa, Chisato Izumi, Masashi Amano, Makoto Miyake, Kosuke Takahashi, Ichiro Shiojima, Yoko Miyasaka, Hirofumi Maeba, Yoshinobu Suwa, Naoyuki Taniguchi, Satoshi Tsujimoto, Takeshi Kitai, Masao Ôta, Satoshi Yuda, S Sasaki, N Hagiwara, Katrina Go Yamazaki, K Ashihara, K Arai, Chihiro Saitou, S Saitou, G Suzuki, Yuichi Shibata, Naoki Watanabe, Shun Nishino, Kohei Ashikaga, Nagato Kuriyama, Keitaro Mahara, Takashi Okubo, H Fujimaki, Hidemasa Shitan, Haruko Yamamoto, Kyohei Abe, M Terada, Shuichiro Takanashi, Masafumi Sata, Hirotsugu Yamada, Kenya Kusunose, Yasuaki Saijo, Haruo Seno, O Yuichiro, T Onishi, Francesco Sera, Satoshi Nakatani, Hiroya Mizuno, K. Sengoku, S W Park, K Eun Kyoung, L Ga Yeon, J-w Hwang, C Jin-Oh, S-J Park, L Sang-Chol, C Sung-A, Se Yong Jang, Ran Heo, S Lee, J-M Song, E. Jung, Jurgita Plisienė, A Dambrauskaite, G Gruodyte, Regina Jonkaitienė, Vaida Mizarienė, J Atkocaityte, Rūta Žvirblytė, Rouguiatou Sow, A. Codreanu, T. Staub, C. Michaux, E Chamorro-De Vega, L Jacobs-Orazi, C. Mallia Azzopardi, Robert G. Xuereb, T. Piscopo, James Farrugia, M Fenech, E Pllaha, Ciro Vella, David Borg, Ramon Casha, L Grib, Elena Raevschi, A Grejdieru, D Kravcenco, E Prisacari, E Samohvalov, S Samohvalov, N Sceglova, E Panfile, L Cardaniuc, V Corcea, A Feodorovici, V Gaina, L Girbu, Pavlina Jimbei, Gheorghe G. Balan, I Cardaniuc, I Benesco, V Marian, N Sumarga, B Božović, Nebojša Bulatović, P Lakovic, Ljilja Musić, Ricardo P.J. Budde, Ali R. Wahadat, T Gamela, T Meijers, Joost P. van Melle, Vincent M. van Deursen, Harry J.G.M. Crijns, S Bekkers, Emile C. Cheriex, M Gilbers, Bas Kietselaer, Christian Knackstedt, Roberto Lorusso, Simon Schalla, Sebastian Streukens, Steven A. J. Chamuleau, M-J Cramer, Arco J. Teske, T Van der Spoel, A Wind, J Lokhorst, O Liesbek, H Van Heusden, Wilco Tanis, Ivo van der Bilt, Joris W.J. Vriend, H De Lange-van Bruggen, E Karijodikoro, Robert K. Riezebos, Elise van Dongen, J Schoep, V Stolk, J T Offstad, J O Beitnes, Thomas Helle-Valle, Helge Skulstad, Rita Skårdal, Nadeem Qamar, Shumaila Furnaz, Bina Ahmed, M H Butt, M F Khanzada, Tahir Saghir, A Wahid, Tomasz Hryniewiecki, Piotr Szymański, Karolina Marzec, M Misztal-Ogonowska, Wojciech Kosmala, M Przewlocka-Kosmala, Amanda Rojek, K Woznicka, J Zachwyc, Anna Lisowska, M. Kamińska, Jarosław D. Kasprzak, Ewelina Kowalczyk, D F Strzecka, Paulina Wejner‐Mik, M Trabulo, P Freitas, Sara Ranchordás, Gabriel Rodrigues, Patrícia Pinto, Catarina Queirós, J Azevedo, L Marques, Daniel Seabra, Luísa Moura Branco, J. Abreu, Madalena Coutinho Cruz, A Galrinho, Rita Ilhão Moreira, Pedro Rio, Ana Teresa Timóteo, Mafalda Selas, Vanda Carmelo, Bernardo Neves, Hélder Pereira, Andrea Guerra, A Marques, I Pintassilgo, Mirela Tomescu, N-M Trofenciuc, Minodora Andor, A Bordejevic, H S Branea, Florin Alexandru Căruntu, L A Velcean, Adelina Mavrea, Mustafa Önel, T Parvanescu, Dana Pop, Adina Pop‐Moldovan, M. I. Puticiu, Liviu Cirin, Ioana Mihaela Citu, Coralia Cotoraci, D Darabantiu, R. Farcas, Iosif Marincu, A. Ionac, Dragoș Cozma, Cristian Mornoş, F Goanta, I Popescu, Ruxandra Beyer, Razvan O. Mada, Raluca Rancea, Raluca Tomoaia, Ştefan Horia Roşian, Cristina Stănescu, Zhanna Kobalava, J Karaulova, E. O. Kotova, A Milto, A. S. Pisaryuk, N Povalyaev, Maria Sorokina, Jamilah AlRahimi, A Elshiekh, Abdulrahman Jamiel, Ali Ahmed, N. Attia, B Putnikovic, Andreja Dimić, Branislava Ivanović, S Matić, Danijela Trifunović, Jelena Petrović, D Kosevic, Ivana Stojanović, Ivana Petrović, P Dabic, Predrag Milojević, Ilija Srdanović, S Susak, Lazar Velicki, Aleksandra Vulin, M Kovacević, Aleksandar Redžek, Maja Stefanović, Tiong Cheng Yeo, William Kong, Kian Keong Poh, Isidre Vilacosta, C Ferrera, Carmen Olmos, M Abd El- Nasser, Francisco Calvo, E Blanco-Gonzalez, M Bravo Amaro, Elena López-Rodríguez, J Lugo Adan, A. Nodar Germiñas, Pablo Pazos-López, M Pereira Loureiro, Maria T. Perez, Sergio Raposeiras‐Roubín, S Rasheed Yas, M-M Suarez-Varela, F Vasallo Vidal, David García‐Dorado, Nuria Fernández‐Hidalgo, Teresa González‐Alujas, J Lozano, Olga Maisterra, Natalia Pizzi, Raquel Ríos, Antoni Bayés‐Genís, L Pedro Botet, Núria Vallejo, C Llibre, Lourdes Mateu, R Nunez, D Quesada, E. Berastegui, D Bosch Portell, J Aboal Vinas, X Bertrán, R Brugada Tarradellas, P Loma-Osorio Ricon, C Tiron de Llano, Miguel Á. Arnau, A. Bel, Marino Blanes, A. Osa, M Anguita, Fernando Carrasco, Juan C. Castillo, J. L. Zamorano, José Luis Moya Mur, M Alvaro, Covadonga Fernández‐Golfín, J M Monteagudo, Enrique Navas, MICHELLE CARRASQUEL ALVAREZ, J Agüero Balbín, Jesús Zarauza, J.F. Gutiérrez-Díez, Carlos Armiñanzas, Francisco Arnaíz de las Revillas, A Arnaiz Garcia, Manuel Cobo Belaustegui, Marta Fernández Sampedro, Manuel Cuadra, L García Cuello, Claudia González-Rico, Regino Rodríguez, Josune Goikoetxea, Miguel Montejo, José M. Miró, Manel Almela, Juan Ambrosioni, Asunción Moreno, Eduard Quintana, Elena Sandoval, Adrián Téllez, José Marı́a Tolosana, Bárbara Vidal, Carlos Falces, David Fuster, C Garcia-de-la-Maria, Marta Hernández‐Meneses, Juan Llopis, Francesc Marco, Isabel Ruíz-Zamora, A Bardaji Ruiz, E. Sanz, Graciano García‐Pardo, Marta Guillén Marzo, A Rodriguez Oviedo, A Villares Jimenez, Leïla Abid, Rania Hammami, S. Kammoun, Mohamed Sami Mourali, F Mghaieth Zghal, Manel Ben Hlima, S. Boudiche, S. Ouali, Lilia Zakhama, S Antit, I. Ben Slama, Okan Gülel, Müjgan Ayşenur Şahin, L E Sade, Emir Karaçağlar, S Kucukoglu, Özge Çetinarslan, Ümit Yaşar Sinan, Uğur Canpolat, Bülent Mutlu, Hakan Ataş, R Dervishova, Çiğdem İleri, J Alhashmi, J Tahir, P Zarger, F Baslib, Simon Woldman, Leon Menezes, C Primus, Rakesh Uppal, I Bvekerwa, Badrinathan Chandrasekaran, A Kopanska, John B. Chambers, Jane Hancock, John L. Klein, Ronak Rajani, Maria Paola Ursi, Stefano Cannata, Rafał Dworakowski, A Fife, John Breeze, M Browne-Morgan, M. Gunning, S Streather, Federico M. Asch, M Zemedkun, B. A. Alyavi, Jamol Uzokov - European Heart Journal 2019 cited by 867

AIMS: The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). METHODS AND RESULTS: Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. CONCLUSION: Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.