Background Infective endocarditis (IE) remains a challenging disease associated with high mortality. Several scores have been suggested to assess surgical risk. None was sufficiently adequate. We therefore analyzed risk factors for 30-day mortality.

Methods A total of 438 consecutive patients had surgery for IE in our department between 2002 and 2020. Patients were divided into two groups, one consisting of 30-day survivors (362 patients; 82.6%) and one of nonsurvivors (76 patients; 17.4%). Logistic regression analysis on pre- and intraoperative risk factors was performed and the groups were compared by univariable analyses.

Results Patients in mortality group were older (69 [58, 77] vs. 63 [50, 72] years; p < 0.001), EuroSCORE II was higher (24.5 [12.1, 49.0] vs. 8.95 [3.7, 21.2]; p < 0.001) and there were more females. More frequently left ventricular function (below 30%), preoperative acute renal insufficiency, chronic dialysis, insulin-dependent diabetes mellitus, NYHA-class IV (New York Heart Association heart failure class IV), and cardiogenic shock occurred. Patients in the mortality group were often intensive care unit patients (40.8 vs. 22.4%; p < 0.001) or had a preoperative stroke (26.3 vs. 16.0%; p = 0.033). In the nonsurvivor group Staphylococcus aureus was prevalent. Streptococcus viridans was common in the survivor group as was isolated aortic valve endocarditis (32.9 vs. 17.1%; p = 0.006). Prosthetic valve endocarditis (PVE) and abscesses occurred more often in nonsurvivors. In the logistic regression analysis, female gender, chronic dialysis, cardiogenic shock, and NYHA IV and from intraoperative variables PVE, cardiopulmonary bypass time, and mitral valve surgery were the strongest predictors for 30-day mortality.

Conclusion This study indeed clearly indicates that significant risk factors for 30-day mortality cannot be changed. Nevertheless, they should be taken into account for preoperative counselling, and they will alert the surgical team for an even more careful management.

背景 感染性心内膜炎（IE）仍然是一种具有高死亡率的挑战性疾病。已经提出了几种评分来评估手术风险。没有一个是足够充分的。因此，我们分析了 30 天死亡率的危险因素。

方法 2002 年至 2020 年期间，共有 438 例连续 IE 患者在我科接受手术。患者分为两组，一组为 30 天存活者（362 例；82.6%），一组为非存活者（76 例；17.4%）。 ）。对术前和术中危险因素进行逻辑回归分析，并通过单变量分析进行组间比较。

结果 死亡率组患者年龄较大（69 [58, 77] vs. 63 [50, 72] 岁；p  < 0.001），EuroSCORE II 较高（24.5 [12.1, 49.0] vs. 8.95 [3.7, 21.2]；p  < 0.001) 并且女性较多。更常见的是左心功能不全（低于30%）、术前急性肾功能不全、慢性透析、胰岛素依赖型糖尿病、NYHA IV级（纽约心脏协会心力衰竭IV级）和心源性休克。死亡组的患者通常是重症监护病房患者（40.8% vs. 22.4%；p  < 0.001）或术前发生过中风（26.3% vs. 16.0%；p  = 0.033）。在非幸存者组中，金黄色葡萄球菌很普遍。草绿色链球菌在幸存者组中很常见，孤立性主动脉瓣心内膜炎也很常见（32.9% vs. 17.1%；p  = 0.006）。人工瓣膜心内膜炎（PVE）和脓肿在非幸存者中更常见。在逻辑回归分析中，女性、慢性透析、心源性休克和 NYHA IV 以及术中变量 PVE、体外循环时间和二尖瓣手术是 30 天死亡率的最强预测因素。

结论 这项研究确实清楚地表明，30 天死亡率的重要危险因素无法改变。尽管如此，术前咨询仍应考虑到他们，他们会提醒手术团队进行更仔细的管理。