Predictive risk factors for periannular extension of native valve endocarditis. Clinical and echocardiographic analyses.

The study objective is to identify clinical, microbiologic, and/or echocardiographic risk factors present early in the course of native valve endocarditis that predict subsequent development of periannular extension of infection. A multivariate computer-generated analysis of 21 clinical-microbiologic parameters and 11 two-dimensional echocardiographic parameters in patients with native valve endocarditis was designed. These parameters were statistically compared in operated-on patients with native valve endocarditis with and without periannular extension of infection. The study took place in a 600-bed acute-care, nonreferral, municipal hospital primarily servicing an indigent patient population. Seventy-three documented episodes of native valve endocarditis occurred between the years of 1973 and 1987, including 29 operated-on patients with surgically confirmed periannular extension of infection and 44 operated-on patients without periannular extension of infection. Multivariate logistic-regression analyses of multiple clinical, microbiologic, and echocardiographic parameters which are potentially predictive of eventual periannular extension of native valve endocarditis were carried out. The only two independent parameters that significantly predicted periannular infection among patients with native valve endocarditis were (1) aortic valve involvement and (2) abuse of intravenous (IV) drugs (p