Ferrera, CarlosVilacosta, IsidreFernández, CristinaLópez, JavierSarriá, CristinaOlmos, CarmenCarnero Alcázar, ManuelVivas Balcones, Luis DavidDi Stefano, SalvatoreSáez, CarmenCobiella, JavierGarcía Arribas, DanielMaroto Castellanos, Luis CarlosSan Román, José Alberto2024-02-072024-02-072018-12-01Carlos Ferrera, Isidre Vilacosta, Cristina Fernández, Javier López, Cristina Sarriá, Carmen Olmos, Manuel Carnero-Alcázar, David Vivas, Salvatore Di Stefano, Carmen Sáez, Javier Cobiella, Daniel García-Arribas, Luis Carlos Maroto Castellanos, J Alberto San Román, Early surgery for acute-onset infective endocarditis, European Journal of Cardio-Thoracic Surgery, Volume 54, Issue 6, December 2018, Pages 1060–1066, https://doi.org/10.1093/ejcts/ezy2081010-794010.1093/ejcts/ezy208https://hdl.handle.net/20.500.14352/99803Objectives: Acute onset of infective endocarditis has been previously linked to the development of septic shock and a worse prognosis. The purpose of this study was to analyse the clinical features and in-hospital evolution of patients with acute-onset endocarditis as well as the potential role of early surgery in the treatment of these patients. Methods: From 1996 to 2014, 1053 consecutive patients with left-sided endocarditis were prospectively included. Patients were classified into 2 groups according to the clinical presentation: patients with acute-onset endocarditis (n = 491) and patients with non-acute endocarditis (n = 562). Acute-onset endocarditis was considered when the time between the appearance of symptoms and diagnosis was <15 days. Results: At admission, acute renal failure, septic shock and cerebral embolism predominated among patients with acute-onset endocarditis. Staphylococcus aureus was more frequently isolated in patients with an acute onset (27.7% vs 7.8% P < 0.001). During hospitalization, patients with acute onset developed systemic embolism and septic shock more frequently. Death was much more common in this group (42.7 vs 30.1%, P < 0.001). Paravalvular complications, nosocomial infection, heart failure, S. aureus and septic shock were predictors of mortality. Acute-onset presentation of endocarditis was strongly associated with increased mortality. Among patients with acute-onset endocarditis, early surgery, performed within the first 2 days after diagnosis, was associated with a 64% of reduction in mortality. Conclusions: Patients with endocarditis and acute onset of symptoms are at high risk of septic in-hospital complications and mortality. Early surgery, performed within the first 2 days after diagnosis, plays a central role in the treatment of these patients.engjournal article1873-734Xhttps://academic.oup.com/ejcts/article/54/6/1060/5033011?login=true29873701https://pubmed.ncbi.nlm.nih.gov/29873701/restricted access616.126-002EndocarditisCardiac surgeryPrognosisCiencias Biomédicas32 Ciencias Médicas