Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study
Authors: Habib Gilbert , Erba Paola Anna , Iung Bernard , Donal Erwan , Cosyns Bernard , Laroche Cécile , Popescu Bogdan A , Prendergast Bernard , Tornos Pilar , Sadeghpour Anita , Oliver Leopold , Vaskelyte Jolanta-Justina , Sow Rouguiatou , Axler Olivier , Maggioni Aldo P , Lancellotti Patrizio ,   EURO-ENDO Investigators, Gale C P , Beleslin B , Budaj A , Chioncel O , Dagres N , Danchin N , Emberson J , Erlinge D , Glikson M , Gray A , Kayikcioglu M , Maggioni A P , Nagy V K , Nedoshivin A , Petronio A-S , Roos-Hesselink J , Wallentin L , Zeymer U , Habib G , Lancellotti P , Cosyns B , Donal E , Erba P , Iung B , Maggioni A P , Popescu B A , Prendergast B , Tornos P , Andarala M , Berle C , Brunel-Lebecq A , Fiorucci E , Laroche C , Missiamenou V , Taylor C , Ali Tatar-Chentir N N , Al-Mallah M , Astrom Aneq M , Athanassopoulos G , Badano L P , Benyoussef S , Calderon Aranda E , Cardim N M , Chan K-L , Cosyns B , Cruz I , Edvardsen T , Goliasch G , Habib G , Hagendorff A , Hristova K , Iung B , Kamp O , Kang D-H , Kong W , Matskeplishvili S , Meshaal M , Mirocevic M , Neskovic A N , Pazdernik M , Plonska-Gosciniak E , Popescu B A , Prendergast B , Raissouni M , Ronderos R , Sade L E , Sadeghpour A , Sambola A , Sengupta S , Separovic-Hanzevacki J , Takeuchi M , Tucay E , Tude Rodrigues A C , Varga A , Vaskelyte J , Yamagata K , Yiangou K , Zaky H , Granada I , Mahia M , Ressi S , Nacinovich F , Iribarren A , Fernandez Oses P , Avegliano G , Filipini E , Obregon R , Bangher M , Dho J , Cartasegna L , Plastino M L , Novas V , Shigel C , Reyes G , De Santos M , Gastaldello N , Granillo Fernandez M , Potito M , Streitenberger G , Velazco P , Casabé J H , Cortes C , Guevara E , Salmo F , Seijo M , Weidinger F , Heger M , Brooks R , Stöllberger C , Ho C-Y , Perschy L , Puskas L , Binder C , Rosenhek R , Schneider M , Winter M-P , Hoffer E , Melissopoulou M , Lecoq E , Legrand D , Jacquet S , Massoz M , Pierard L , Marchetta S , Dulgheru R , Emal C D´ , Oury C , Droogmans S , Kerkhove D , Plein D , Soens L , Weytjens C , Motoc A , Roosens B , Lemoine I , Rodrigus I , Paelinck B , Amsel B , Unger P , Konopnicki D , Beauloye C , Pasquet A , Vanoverschelde J L , Pierard S , Vancraeynest D , Sinnaeve F , Andrade J L , Staszko K , Dos Santos Monteiro R , Miglioranza M H , Shuha D L , Alcantara M , Cravo V , Fazzio L , Felix A , Iso M , Musa C , Siciliano A P , Villaca Filho F , Rodrigues A , Vilela F , Braga J , Silva R , Rodrigues D , Silva L , Morhy S , Fischer C , Silva R , Vieira M , Afonso T , Abreu J , Falcao S N , Moises V A , Gouvea A , Mancuso F J , Souza A C , Silva C Y , João G , Abboud C S , Bellio de Mattos Barretto R , Ramos A , Arnoni R , Assef J E , Della Togna D J , Le Bihan D , Miglioli L , Romero Oliveira A P , Tadeu Magro Kroll R , Cortez D , Gelape C L , Peirira Nunes M d C , De Abreu Ferrari T C , Hay K , Le V , Page M , Poulin F , Sauve C , Serri K , Mercure C , Beaudoin J , Pibarot P , Sebag I A , Rudski L G , Ricafort G , Barsic B , Krajinovic V , Vargovic M , Lovric D , Reskovic-Luksic V , Vincelj J , Jaksic Jurinjak S , Yiannikourides V , Ioannides M , Pofaides C , Masoura V , Pudich J , Linhart A , Siranec M , Marek J , Blechova K , Kamenik M , Pelouch R , Coufal Z , Mikulica M , Griva M , Jancova E , Mikulcova M , Taborsky M , Precek J , Jecmenova M , Latal J , Widimsky J , Butta T , Machacek S , Vancata R , Spinar J , Holicka M , Pow Chon Long F , Anzules N , Bajana Carpio A , Largacha G , Penaherrera E , Moreira D , Mahfouz E , Elsafty E , Soliman A , Zayed Y , Aboulenein J , Abdel-Hay M , Almaghraby A , Abdelnaby M , Ahmed M , Hammad B , Saleh Y , Zahran H , Elgebaly O , Saad A , Ali M , Zeid A , El Sharkawy R , Al Kholy A , Doss R , Osama D , Rizk H , Elmogy A , Mishriky M , Assayag P , El Hatimi S , Hubert S , Casalta J-P , Gouriet F , Arregle F , Cammilleri S , Tessonnier L , Riberi A , Botelho-Nevers E , Gagneux-Brunon A , Pierrard R , Tulane C , Campisi S , Fuzellier J-F , Detoc M , Mehalla T , Boutoille D , Lecompte A S , Lefebvre M , Pattier S , Al Habash O , Asseray-Madani N , Biron C , Brochard J , Caillon J , Cueff C , Le Tourneau T , Lecomte R , Magali Michel M M , Orain J , Delarue S , Le Bras M , Faucher J-F , Aboyans V , Beeharry A , Durox H , Lacoste M , Magne J , Mohty D , David A , Pradel V , Sierra V , Neykova A , Bettayeb B , Elkentaoui S , Tzvetkov B , Landry G , Strady C , Ainine K , Baumard S , Brasselet C , Tassigny C , Valente-Pires V , Lefranc M , Hoen B , Lefevre B , Curlier E , Callier C , Fourcade N , Jobic Y , Ansard S , Le Berre R , Le Ven F , Pouliquen M-C , Prat G , Le Roux P , Bouchart F , Savoure A , Alarcon C , Chapuzet C , Gueit I , Tribouilloy C , Bohbot Y , Peugnet F , Gun M , Duval X , Lescure X , Ilic-Habensus E , Sadoul N , Selton-Suty C , Alla F , Goehringer F , Huttin O , Chevalier E , Garcia R , Le Marcis V , Tattevin P , Flecher E , Revest M , Chirouze C , Bouiller K , Hustache-Mathieu L , Klopfenstein T , Moreau J , Fournier D , Brunel A-S , Lim P , Oliver L , Ternacle J , Moussafeur A , Chavanet P , Piroth L , Salmon-Rousseau A , Buisson M , Mahy S , Martins C , Gohier S , Axler O , Baumann F , Lebras S , Piper C , Guckel D , Börgermann J , Horstkotte D , Winkelmann E , Brockmeier B , Grey D , Nickenig G , Schueler R , Öztürk C , Stöhr E , Hamm C , Walther T , Brandt R , Frühauf A-C , Hartung C T , Hellner C , Wild C , Becker M , Hamada S , Kaestner W , Stangl K , Knebel F , Baldenhofer G , Brecht A , Dreger H , Isner C , Pfafflin F , Stegemann M , Zahn R , Fraiture B , Kilkowski C , Karcher A-K , Klinger S , Tolksdorf H , Tousoulis D , Aggeli C , Sideris S , Venieri E , Sarri G , Tsiapras D , Armenis I , Koutsiari A , Floros G , Grassos C , Dragasis S , Rallidis L , Varlamos C , Michalis L , Naka K , Bechlioulis A , Kotsia A , Lakkas L , Pappas K , Papadopoulos C , Kiokas S , Lioni A , Misailidou S , Barbetseas J , Bonou M , Kapelios C , Tomprou I , Zerva K , Manolis A , Hamodraka E , Athanasiou D , Haralambidis G , Samaras H , Poulimenos L , Nagy A , Bartykowszki A , Gara E , Mungulmare K , Kasliwal R , Bansal M , Ranjan S , Bhan A , Kyavar M , Maleki M , Noohi Bezanjani F , Alizadehasl A , Boudagh S , Ghavidel A , Moradnejad P , Pasha H R , Ghadrdoost B , Gilon D , Strahilevitz J , Wanounou M , Israel S , d'Agostino C , Colonna P , De Michele L , Fumarola F , Stante M , Marchionni N , Scheggi V , Alterini B , Del Pace S , Stefano P , Sparano C , Ruozi N , Tenaglia R , Muraru D , Limbruno U , Cresti A , Baratta P , Solari M , Giannattasio C , Moreo A , De Chiara B , Lopez Montero B , Musca F , Orcese C A , Panzeri F , Spano F , Russo C F , Alfieri O , De Bonis M , Chiappetta S , Del Forno B , Ripa M , Scarpellini P , Tassan Din C , Castiglioni B , Pasciuta R , Carletti S , Ferrara D , Guffanti M , Iaci G , Lapenna E , Nisi T , Oltolini C , Busnardo E , Pajoro U , Agricola E , Meneghin R , Schiavi D , Piscione F , Citro R , Benvenga R M , Greco L , Soriente L , Radano I , Prota C , Bellino M , Di Vece D , Santini F , Salsano A , Olivieri G M , Turrini F , Messora R , Tondi S , Olaru A , Agnoletto V , Grassi L , Leonardi C , Sansoni S , Del Ponte S , Actis Dato G M , De Martino A , Ohte N , Kikuchi S , Wakami K , Aonuma K , Seo Y , Ishizu T , Machino-Ohtsuka T , Yamamoto M , Iida N , Nakajima H , Nakagawa Y , Izumi C , Amano M , Miyake M , Takahashi K , Shiojima I , Miyasaka Y , Maeba H , Suwa Y , Taniguchi N , Tsujimoto S , Kitai T , Ota M , Yuda S , Sasaki S , Hagiwara N , Yamazaki K , Ashihara K , Arai K , Saitou C , Saitou S , Suzuki G , Shibata Y , Watanabe N , Nishino S , Ashikaga K , Kuriyama N , Mahara K , Okubo T , Fujimaki H , Shitan H , Yamamoto H , Abe K , Terada M , Takanashi S , Sata M , Yamada H , Kusunose K , Saijo Y , Seno H , Yuichiro O , Onishi T , Sera F , Nakatani S , Mizuno H , Sengoku K , Park S W , Eun Kyoung K , Ga Yeon L , Hwang J-w , Jin-Oh C , Park S-J , Sang-Chol L , Sung-A C , Jang S Y , Heo R , Lee S , Song J-M , Jung E , Plisiene J , Dambrauskaite A , Gruodyte G , Jonkaitiene R , Mizariene V , Atkocaityte J , Zvirblyte R , Sow R , Codreanu A , Staub T , Michaux C , De la Vega E C L , Jacobs-Orazi L , Mallia Azzopardi C , Xuereb R G , Piscopo T , Farrugia J , Fenech M , Pllaha E , Vella C , Borg D , Casha R , Grib L , Raevschi E , Grejdieru A , Kravcenco D , Prisacari E , Samohvalov E , Samohvalov S , Sceglova N , Panfile E , Cardaniuc L , Corcea V , Feodorovici A , Gaina V , Girbu L , Jimbei P , Balan G , Cardaniuc I , Benesco I , Marian V , Sumarga N , Bozovic B , Bulatovic N , Lakovic P , Music L , Budde R , Wahadat A , Gamela T , Meijers T , Van Melle J P , Deursen V M , Crijns H J , Bekkers S C , Cheriex E C , Gilbers M , Kietselaer B L , Knackstedt C , Lorusso R , Schalla S , Streukens S A , Chamuleau S , Cramer M-J , Teske A , Van der Spoel T , Wind A , Lokhorst J , Liesbek O , Van Heusden H , Tanis W , Van der Bilt I , Vriend J , De Lange-van Bruggen H , Karijodikoro E , Riezebos R , van Dongen E , Schoep J , Stolk V , Offstad J T , Beitnes J O , Helle-Valle T , Skulstad H , Skardal R , Qamar N , Furnaz S , Ahmed B , Butt M H , Khanzada M F , Saghir T , Wahid A , Hryniewiecki T , Szymanski P , Marzec K , Misztal-Ogonowska M , Kosmala W , Przewlocka-Kosmala M , Rojek A , Woznicka K , Zachwyc J , Lisowska A , Kaminska M , Kasprzak J D , Kowalczyk E , Strzecka D F , Wejner-Mik P , Trabulo M , Freitas P , Ranchordas S , Rodrigues G , Pinto P , Queiros C , Azevedo J , Marques L , Seabra D , Branco L , Abreu J , Cruz M , Galrinho A , Moreira R , Rio P , Timoteo A T , Selas M , Carmelo V , Duque Neves B , Pereira H , Guerra A , Marques A , Pintassilgo I , Tomescu M C , Trofenciuc N-M , Andor M , Bordejevic A , Branea H S , Caruntu F , Velcean L A , Mavrea A , Onel M F , Parvanescu T , Pop D , Pop-Moldovan A L , Puticiu M I , Cirin L , Citu I M , Cotoraci C A , Darabantiu D , Farcas R , Marincu I , Ionac A , Cozma D , Mornos C , Goanta F , Popescu I , Beyer R , Mada R , Rancea R , Tomoaia R , Rosianu H , Stanescu C , Kobalava Z , Karaulova J , Kotova E , Milto A , Pisaryuk A , Povalyaev N , Sorokina M , Alrahimi J , Elshiekh A , Jamiel A , Ahmed A , Attia N , Putnikovic B , Dimic A , Ivanovic B , Matic S , Trifunovic D , Petrovic J , Kosevic D , Stojanovic I , Petrovic I , Dabic P , Milojevic P , Srdanovic I , Susak S , Velicki L , Vulin A , Kovacevic M , Redzek A , Stefanovic M , Yeo T C , Kong W KF , Poh K K , Vilacosta I , Ferrera C , Olmos C , Abd El- Nasser M , Calvo Iglesias F , Blanco-Gonzalez E , Bravo Amaro M , Lopez-Rodriguez E , Lugo Adan J , Germinas A N , Pazos-Lopez P , Pereira Loureiro M , Perez M T , Raposeiras-Roubin S , Rasheed Yas S , Suarez-Varela M-M , Vasallo Vidal F , Garcia-Dorado D , Fernandez-Hidalgo N , Gonzalez-Alujas T , Lozano J , Maisterra O , Pizzi N , Rios R , Bayes-Genis A , Pedro Botet L , Vallejo N , Llibre C , Mateu L , Nunez R , Quesada D , Berastegui E , Bosch Portell D , Aboal Vinas J , Albert Bertran X , Brugada Tarradellas R , Loma-Osorio Ricon P , Tiron de Llano C , Arnau M A , Bel A , Blanes M , Osa A , Anguita M , Carrasco F , Castillo J C , Zamorano J L , Moya Mur J L , Alvaro M , Fernandez-Golfin C , Monteagudo J M , Navas Elorza E , Farinas Alvarez M C , Aguero Balbin J , Zarauza J , Gutierrez-Diez J F , Arminanzas C , Arnaiz de las Revillas F , Arnaiz Garcia A , Cobo Belaustegui M , Fernandez Sampedro M , Gutierrez Cuadra M , Garcia Cuello L , Gonzalez Rico C , Rodriguez-Alvarez R , Goikoetxea J , Montejo M , Miro J M , Almela M , Ambrosioni J , Moreno A , Quintana E , Sandoval E , Tellez A , Tolosana J M , Vidal B , Falces C , Fuster D , Garcia-de-la-Maria C , Hernandez-Meneses M , Llopis J , Marco F , Ruiz-Zamora I , Bardaji Ruiz A , Sanz Girgas E , Garcia-Pardo G , Guillen Marzo M , Rodriguez Oviedo A , Villares Jimenez A , Abid L , Hammami R , Kammoun S , Mourali M S , Zghal F Mghaieth , Ben Hlima M , Boudiche S , Ouali S , Zakhama L , Antit S , Slama I , Gulel O , Sahin M , Sade L E , Karacaglar E , Kucukoglu S , Cetinarslan O , Sinan U Y , Canpolat U , Mutlu B , Atas H , Dervishova R , Ileri C , Alhashmi J , Tahir J , Zarger P , Baslib  F , Woldman S , Menezes L , Primus C , Uppal R , Bvekerwa I , Chandrasekaran B , Kopanska A , Chambers J , Hancock J , Klein J , Rajani R , Ursi M P , Cannata S , Dworakowski R , Fife A , Breeze J , Browne-Morgan M , Gunning M , Streather S , Asch F M , Zemedkun M , Alyavi B , Uzokov J 
Published: August 2019

Abstract

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 &gt; 2 mg/dL, congestive heart failure, vegetation length &gt; 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.