, Reza Arsanjani 2
, Pradyumna Agasthi 2
, Panwen Wang 3
, Banveet K. Khetarpal 4
, Timothy Barry 2
, Chieh-Ju Chao 2
, Ayman Fath 2
, Farouk Mookadam 5
2Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
3Department of Health Sciences Research, Mayo Clinic, Phoenix, Arizona, USA
4Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
5Department of Cardiovascular Diseases, University of Arizona, Phoenix, Arizona, USA
Abstract
Background: Nonbacterial thrombotic endocarditis is characterized by the presence of organized thrombi on cardiac valves, often associated with hypercoagulable states. There is a paucity of data regarding the predictors of mortality in patients with nonbacterial thrombotic endocarditis. Our primary aim was to identify predictors of in-hospital mortality in patients with nonbacterial thrombotic endocarditis.
Methods: A systematic literature review of all published cases and case series was performed until May 2018 according to Preferred Reporting Items for Systematic Review and Meta-analyses statement guidelines. We applied random forest machine learning model to identify predictors of in-patient mortality in patients with nonbacterial thrombotic endocarditis.
Results: Our search generated a total of 163 patients (mean age, 46 ± 17 years; women, 69%) with newly diagnosed nonbacterial thrombotic endocarditis. The in-hospital mortality rate in the study cohort was 30%. Among the patients who died in the hospital, initial presentation of pulmonary embolism (12.2 vs. 2.6%), splenic (38.7 vs. 10.5%), and renal (40.8 vs. 9.6%) infarcts were higher compared to patients alive at the time of discharge. Higher rates of malignancy (71.4 vs. 39.4%, P =.0003) and lower rates of antiphospholipid syndrome (8.1 vs. 48.2%, P =.0001) were noted in deceased patients. Random forest machine learning analysis showed that older age, presence of antiphospholipid syndrome, splenic infarct, renal infarct, peripheral thromboembolism, pulmonary embolism, myocardial infarction, and mitral valve regurgitation were significantly associated with increased risk of in-hospital mortality.
Conclusion: Patients admitted with nonbacterial thrombotic endocarditis have a high rate of in-hospital mortality. Factors including older age, presence of antiphospholipid syndrome, splenic/renal infarct, lower limb thromboembolism, pulmonary embolism, myocardial infarction, and mitral valve regurgitation were significantly associated with increased risk of in-hospital mortality in patients with nonbacterial thrombotic endocarditis.