Rinaldo Focaccia Siciliano

A endocardite infecciosa permanece uma condição grave e de manejo complexo, com elevadas taxas de morbimortalidade, apesar dos avanços diagnósticos e terapêuticos. Enquanto o Norte Global tem observado uma transição para pacientes mais idosos com infecções em próteses valvares, a compreensão da doença no Brasil é dificultada pela dependência de dados fragmentados, baseados em hospitais, principalmente da região Sudeste. Esta revisão narrativa sintetiza evidências recentes para delinear o panorama nacional. Estudos populacionais indicam aumento na incidência e na mortalidade, afetando principalmente homens e idosos, mas com marcada heterogeneidade regional. As análises de séries de casos hospitalares revelam um perfil epidemiológico caracterizado por pacientes mais jovens do que as médias internacionais, com alta prevalência de comorbidades, doenças cardíacas estruturais subjacentes e próteses valvares. O cenário microbiológico é diverso, sem um padrão consistente de predominância entre estafilococos e estreptococos. Ainda assim, um achado particularmente preocupante é a alta incidência de hemoculturas negativas registradas. Complicações graves são frequentes e há variabilidade nas taxas de intervenção cirúrgica e mortalidade hospitalar entre os estudos. Diante desse cenário, os autores propõem um conjunto de ações estratégicas para orientar avanços futuros: a criação de um Registro Brasileiro de Endocardite Infecciosa, o desenvolvimento de Diretrizes Nacionais Contextualizadas, o fortalecimento de equipes multidisciplinares (Endocarditis Teams) e a implementação de medidas com potenciais para reduzir disparidades regionais, como a telemedicina e a regionalização do cuidado A consolidação dessas iniciativas tem o potencial de transformar o panorama atual, aprimorando o conhecimento epidemiológico, padronizando práticas assistenciais e, em última instância, melhorando os desfechos clínicos em âmbito nacional.

Objective: This study aimed to characterize the cardiological and dental profiles of patients with rheumatic fever (RF) and assess the impact on their oral health-related quality of life (OHRQoL). Methods: A cross-sectional study was conducted from March to December 2023. Clinical analysis included the DMFT index and OHI-S, along with medical record review, economic stratification (Brazilian Association of Research Companies questionnaire), panoramic radiographs, and OHRQoL assessment (OHIP-14). Participants were patients followed at the Rheumatic Fever League, Heart Institute, University of São Paulo Medical School. Results: The study included 83 predominantly female patients (90.4%), with a mean age of 47 years. Most were Afro-Brazilian (61.4%) and from lower-middle economic classes with limited education. Rheumatic heart disease (RHD) was present in 97.5%, mainly affecting the mitral valve. Infective endocarditis was observed in 6%. The mean DMFT was 19.6, with an average of nine missing teeth. The OHI-S was satisfactory in 50%. Among 52 radiographed patients, 55.7% had dental caries, 78.8% had periapical lesions, and 76.8% were at moderate to high risk of periodontal disease. Despite poor oral health indicators, OHRQoL scores showed minimal impact. Conclusion: Despite significant oral health issues, these did not substantially impact the OHRQoL of the studied population.

Infective endocarditis (IE) remains a life-threatening condition with high mortality, particularly in middle-income countries where access to advanced diagnostics and timely surgery is unequal. Real-world data from such settings remain limited. This study describes the clinical and microbiological characteristics of patients with suspected IE and identifies independent predictors of in-hospital mortality at a Brazilian tertiary referral center. We conducted a retrospective cohort including adults hospitalized with suspected IE between 2012 and 2022. Cases were classified according to modified Duke criteria. Demographic, clinical, laboratory, microbiological, and echocardiographic data were collected, and independent predictors of in-hospital mortality were identified using multivariable logistic regression. Of the 112 patients evaluated, 66 met the criteria for definite or possible IE. Median age was 55 years, 59.1% were male, and 34.8% were ≥60 years. Structural heart disease was present in 87.8%, predominantly involving the mitral valve. Blood cultures were positive in 57.1%, with Staphylococcus aureus as the leading pathogen (25%), whereas 42.9% were culture-negative. Echocardiographic evidence of IE was documented in 80.9%, and valve surgery was performed in 51.5%. In-hospital mortality was 36.6%. Independent predictors of death included age ≥60 years (OR 7.0), hypertension (OR 3.9), new valvular regurgitation (OR 6.3), thrombocytopenia ≤150×10³/mm³ (OR 3.5), total bilirubin ≥1.2 mg/dL (OR 15.4), and arterial lactate >1.6 mmol/L (OR 5.2). In this real-world cohort, IE was characterized by diagnostic limitations, a high proportion of culture-negative cases, and high in-hospital mortality. Readily available clinical and laboratory parameters showed prognostic value and may support early risk stratification in resource-limited settings.

Infective endocarditis is an infection of the endocardium, associated with high morbidity and mortality, particularly when the left heart chambers are involved. Timely diagnosis and appropriate intervention can attenuate these outcomes. The objective of this study was to create and validate the EndoPredict-Px score for early in-hospital mortality prediction in patients with left-sided infective endocarditis. This analysis focused on patients admitted to the emergency department with left-sided infective endocarditis defined by the Duke-ISCVID criteria, from January 2011 to January 2020. The main outcome was in-hospital mortality. Among 530 patients with left-sided infective endocarditis, 160 (30.2%) died during hospitalization. The score included age ≥ 60 years, absence of fever, NYHA functional class III or IV heart failure, suspected embolism, hemoglobin level ≤ 10 g/dL, leukocyte level ≥ 12 × 10⁹/L, platelet level ≥ 150 × 10⁹/L, and creatinine level ≥ 1.3 mg/dL. Patients were categorized into three mortality risk groups. The model displayed an AUROC of 0.76 (95% CI 0.71–0.80) and 0.74 in the bootstrap validation. Both the derivation and validation models showed accurate calibration. In conclusion, the EndoPredict-Px score accurately and early predicted in-hospital mortality in patients with left-sided infective endocarditis.

Infective endocarditis remains a serious condition with high morbidity and mortality rates despite advances in diagnostic and therapy. While the

Background: As infective endocarditis has particular characteristics compared to other infectious diseases, it is not clear if sepsis scores are reported with good accuracy in these patients. The aim of this study is to evaluate the accuracy of the qSOFA and SOFA scores to predict mortality in patients with infective endocarditis. Methods: Between January 2010 and June 2019, 867 patients with suspected left-sided endocarditis were evaluated; 517 were included with left-sided infective endocarditis defined as “possible” or “definite” endocarditis, according to the Modified Duke Criteria. ROC curves were constructed to assess the accuracy of qSOFA and SOFA sepsis scores for the prediction of in-hospital mortality. Results: The median age was 57 years, 65% were male, 435 (84%) had pre-existing heart valve disease, and the overall mortality was 28%. The most frequent etiologies were Streptococcus spp. (36%), Enterococcus spp. (10%), and Staphylococcus aureus (9%). The sepsis scores from the ROC curves used to predict in-hospital mortality were qSOFA 0.601 (CI95% 0.522–0.681) and SOFA score 0.679 (CI95% 0.602–0.756). A sub-group analysis in patients with and without pre-existing valve disease for SOFA ≥ 2 showed ROC curves of 0.627 (CI95% 0.563–0.690) and 0.775 (CI95% 0.594–0.956), respectively. Conclusions: qSOFA and SOFA scores were associated with increased in-hospital mortality in patients with infective endocarditis. However, as accuracy was relatively lower compared to other sites of bacterial infections, we believe that this score may have lower accuracy when predicting the prognosis of patients with IE, because, in this disease, the patient’s death may be more frequently linked to valvular and cardiac dysfunction, as well as embolic events, and less frequently directly associated with sepsis.

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