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Prognosis varies widely depending on a number of factors. (1) Predictors of poor outcome include;

Patient characteristics: older age, prosthetic valve IE, diabetes, comorbidity (eg, frailty, immunosuppression, renal or pulmonary disease).

Clinical complications such as heart or renal failure, brain haemorrhage, septic shock.

Micro-organism: S. aureus, fungi, non-HACEK Gram-negative bacilli.

Echocardiogram findings: peri-annular complications, severe left-sided valve regurgitation, low left ventricular ejection fraction, pulmonary hypertension, large vegetations, severe prosthetic valve dysfunction, premature mitral valve closure and other signs of elevated diastolic pressures.

  • The overall mortality rate remains at 30% (2) with subsets including:
  • S. viridans 4-16% mortality
  • S. aureus 25-47% mortality
  • fungal infections - over 50% mortality
  • right-sided endocarditis in IV drug abusers - about 10% mortality

For infective endocarditis following prosthetic valve replacement, early endocarditis 30-70% mortality and late endocarditis 20-30% mortality.

Increased mortality rates are associated with increased age, infection involving the aortic valve, development of congestive heart failure, central nervous system complications and underlying disease.


1. European Society of Cardiology (Aug 2023). 2023 ESC Guidelines for the management of infective endocarditis.

2. Cahill TJ, Prendergast BD. Infective endocarditis. Lancet. 2015 September.


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