, Volume 47, Issue 6, pp 879–895 | Cite as

Prognostic factors of mortality after surgery in infective endocarditis: systematic review and meta-analysis

  • Laura Varela BarcaEmail author
  • Enrique Navas Elorza
  • Nuria Fernández-Hidalgo
  • Jose Luis Moya Mur
  • Alfonso Muriel García
  • B. M. Fernández-Felix
  • Javier Miguelena Hycka
  • Jorge Rodríguez-Roda
  • Jose López-Menéndez



There is a lack of consensus about which endocarditis-specific preoperative characteristics have an actual impact over postoperative mortality. Our objective was the identification and quantification of these factors.


We performed a systematic review of all the studies which reported factors related to in-hospital mortality after surgery for acute infective endocarditis, conducted according to PRISMA recommendations. A search string was constructed and applied on three different databases. Two investigators independently reviewed the retrieved references. Quality assessment was performed for identification of potential biases. All the variables that were included in at least two validated risk scores were meta-analyzed independently, and the pooled estimates were expressed as odds ratios (OR) with their confidence intervals (CI).


The final sample consisted on 16 studies, comprising a total of 7484 patients. The overall pooled OR were statistically significant (p < 0.05) for: age (OR 1.03, 95% CI 1.00–1.05), female sex (OR 1.56, 95% CI 1.35–1.81), urgent or emergency surgery (OR 2.39 95% CI 1.91–3.00), previous cardiac surgery (OR 2.19, 95% CI 1.84–2.61), NYHA ≥ III (OR 1.84, 95% CI 1.33–2.55), cardiogenic shock (OR 4.15, 95% CI 3.06–5.64), prosthetic valve (OR 1.98, 95% CI 1.68–2.33), multivalvular affection (OR 1.35, 95% CI 1.01–1.82), renal failure (OR 2.57, 95% CI 2.15–3.06), paravalvular abscess (OR 2.39, 95% CI 1.77–3.22) and S. aureus infection (OR 2.27, 95% CI 1.89–2.73).


After a systematic review, we identified 11 preoperative factors related to an increased postoperative mortality. The meta-analysis of each of these factors showed a significant association with an increased in-hospital mortality after surgery for active infective endocarditis.

Graphic abstract

Graph summary of the Pooled Odds Ratios of the 11 preoperative factors analyzed after the systematic review and meta-analysis.


Infective endocarditis Prognostic factors Systematic review Meta-analysis 



The present authors sincerely thank Noelia Álvarez for his contribution to the literature search.


This research received no specific grant from any funding agency, commercial or non-profit.

Compliance with ethical standards

Conflict of interest

There was no conflict of interest.

Ethical approval

The Ethical Review Board (ERB) of the Hospital approved the implementation of this study (ERB number 313/2016, approved on November 28, 2016).

Informed consent

The requirement for informed written consent was waived. Patient identification was encoded, complying with the requirements of the Organic Law on Data Protection 15/1999.

Supplementary material

15010_2019_1338_MOESM1_ESM.doc (62 kb)
Supplementary material 1 (DOC 62 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  • Laura Varela Barca
    • 1
    Email author
  • Enrique Navas Elorza
    • 2
  • Nuria Fernández-Hidalgo
    • 3
  • Jose Luis Moya Mur
    • 4
  • Alfonso Muriel García
    • 5
  • B. M. Fernández-Felix
    • 5
    • 6
  • Javier Miguelena Hycka
    • 1
  • Jorge Rodríguez-Roda
    • 1
  • Jose López-Menéndez
    • 1
  1. 1.Department of Cardiovascular SurgeryUniversity Hospital Ramon y CajalMadridSpain
  2. 2.Department of InfectologyUniversity Hospital Ramon y CajalMadridSpain
  3. 3.Department of Infectious DiseasesUniversity Hospital Vall d’HebronBarcelonaSpain
  4. 4.Department of CardiologyUniversity Hospital Ramon y CajalMadridSpain
  5. 5.Clinical Biostatistics UnitHospital Ramon y Cajal (IRYCIS)MadridSpain
  6. 6.CIBER Epidemiology and Public Health (CIBERESP)MadridSpain

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