Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis

3.69,P ¼ 0.025); vegetation size ≥15 mm (HR 1.64; 95% CI 1.03-2.63,P ¼ 0.038); and cardiac surgery (HR (95%CI), 0.33 (0.16-0.67) for surgery ≤1 day after IE diagnosis; 0.61 (0.29-1.26) for surgery 2-7 days after IE diagnosis; 0.42 (0.21- 0.83) for surgery .7 days after IE diagnosis; reference category no surgery; P ¼ 0.005). One hundred and three (52%) patients underwent cardiac surgery after a median time of 6 (16) days. Independent predictors of surgical intervention on multivariate analysis were: age ≤60 years (Odds ratio (OR) 5.30; 95% CI (2.46-11.41), P , 0.01), heart failure (OR 3.27; 95% CI (1.03-10.35), P ¼ 0.04), cardiogenic shock (OR 3.31; 95% CI (1.47-7.46), P ¼ 0.004), septic shock (OR 0.25; 95% CI (0.11-0.59),P ¼ 0.002), immunosuppression (OR 0.15; 95% CI (0.04-0.55),P ¼ 0.004), and diagnosis before or within 24 h of ICU admission (OR 2.81; 95% CI (1.14-6.95), P ¼ 0.025). SOFA score calculated the day of surgery was the only independently associated factor with long-term mortality (HR (95% CI) 1.59 (0.77-3.28) for SOFA 5-9; 3.56 (1.71-7.38) for SOFA 10-14; 11.58 (4.02-33.35) for SOFA 15-20; reference category SOFA 0-4; P , 0.0001). Surgical timing was not associated with post-operative outcomes. Of the 158 patients with a theoretical in- dication for surgery, the 58 deemed not fit had a 95% mortality rate.