Thorac Cardiovasc Surg 2016; 64 - ePP20
DOI: 10.1055/s-0036-1571703

Impact of Perioperative Liver Dysfunction on In-Hospital Mortality and Long-Term Survival in Infective Endocarditis Patients

M. Diab 1, C. Sponholz 2, M. Bauer 2, A. Kortgen 2, P. Scheffel 2, T. Lehmann 3, G. Faerber 1, W. Pletz M. 4, T. Doenst 1
  • 1Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
  • 2Department of Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany
  • 3Friedrich-Schiller-University Jena, Center for Clinical Studies, Jena, Germany
  • 4Friedrich-Schiller-University Jena, Center for Infectious Diseases and Infection Control, Jena, Germany

Background: Infective endocarditis (IE) is still associated with high mortality (20–40%). One of the leading causes of death in IE patients is multiple organ dysfunction syndrome (MODS). Liver dysfunction (LD) is one of the MODS components that portends poor prognosis. Data about its incidence and predisposing factors in IE patients are scarce. We investigated IE patients for factors predisposing to perioperative LD and its impact on in-hospital mortality and long-term survival.

Methods: We reviewed data from patients operated for left-sided endocarditis in our center between 01/2007 and 04/2013. We used the hepatic Sepsis-related Organ Failure Assessment (hSOFA) score to assess the degree of LD. We performed chi-square, cox regression, and multivariate analyses.

Results: A total of 308 patients with mean age of 62 ± 13.9 underwent surgery for IE during this period. Preoperative LD (hSOFA > 0, Bilirubin > 32 µmol/L) occurred in 81 (26.3%) of patients and was associated with higher in-hospital mortality of 51.9% and poor actuarial 7-year survival (24%) compared with 14.6 and 53% in patients without preoperative LD (p < 0.001). Multivariate Cox regression analysis revealed preoperative LD (hSOFA > 0) as an independent predictor of long-term survival (adjusted hazard ratio: 1.695, 95% CI: 1.160–2.477, p = 0.009). Univariate analysis revealed a significant relationship between preoperative LD and preoperative septic shock, infection with S. aureus, congestive heart failure and preoperative renal insufficiency. Newly-occurring postoperative LD developed in 57 (18.5%) additional patients and was associated with 24.6% in-hospital mortality in this subgroup compared with 11.2% in patients without pre- or postoperative LD (p < 0.001). Multivariate analysis identified duration of cardiopulmonary bypass (CPB) and S. aureus infection as independent predictors of newly-occurring postoperative LD. The mean duration of CPB in patients with new postoperative LD compared with patients without was 154.1 ± 120 versus 120 ± 186 minutes, respectively (p < 0.001).

Conclusion: The presence or the development of LD (hSOFA score >0) in patients with IE is associated with extraordinarily high in-hospital mortality and poor long-term survival. The development of postoperative liver dysfunction is independently influenced by duration of CPB and infection by S. aureus.