Dissecting the correlates of N-terminal prohormone brain natriuretic peptide in acute infective endocarditis

Clinical correlates of circulating small dense low-density lipoproteins in acute infective endocarditis

BACKGROUND AND AIM

Infective endocarditis (IE) is a complex thrombo-inflammatory disorder, the pathogenesis of which involves a multifaceted interplay between vascular damage and bacterial virulence factors. This study aimed to assess the prognostic role of small dense low-density lipoprotein (sdLDL) cholesterol in patients with IE and its correlation with various disease-related features.

METHODS

A cohort of 198 patients with definite IE was included in this study. Clinical, laboratory, and echocardiographic parameters were meticulously analyzed, with a specific focus on comorbidities. sdLDL levels were measured using stored plasma samples obtained upon admission during the acute phase of the disease.

RESULTS

The median level of sdLDL was 24 mg/dL [with an interquartile range of 17.9-35.2 mg/dL], and this value showed a statistically significant positive correlation with LDL/HDL cholesterol and triglycerides (p < 0.01 for all). Furthermore, a remarkable inverse correlation between C-reactive protein and D-dimer levels was observed (p < 0.0001). Univariate analysis revealed that patients with sdLDL levels ≤ 24 mg/dL had 2.75 times higher odds of in-hospital mortality (95% Confidence Interval:1.08-6.98, p = 0.031). In addition, nonsurvivors had significantly lower median sdLDL levels (19.7 vs. 26.0 mg/dL, p = 0.041). Lower sdLDL levels were also associated with embolic complications, larger vegetation size, and positive blood cultures for Staphylococci (p = 0.019, p = 0.022, and p < 0.001, respectively).

CONCLUSIONS

Low circulating sdLDL levels in the acute phase of IE were significantly correlated with unfavorable clinical outcomes. These results suggest that the sdLDL level may serve as an important marker of disease severity in IE and may represent a link between vascular damage, embolic complications, and disease progression.

B-type natriuretic peptide levels at admission predict the prognosis of patients with infective endocarditis undergoing cardiac surgery

Purpose: The objective of this study was to explore the relationship between elevated B-type natriuretic peptide (BNP) levels and the prognosis of patients with infective endocarditis (IE) undergoing cardiac surgery. Methods: In total, 162 IE patients with recorded BNP levels upon admission were included in the present study. The primary end point was all-cause mortality. Results: Multivariate Cox analysis revealed a significant association between log BNP and all-cause mortality. Kaplan-Meier analysis revealed a poorer prognosis for patients with BNP levels ≥ the 75th percentile. Furthermore, the linear trend test indicated a significant link between BNP quartiles and the primary end point within the models. Conclusion: Elevated BNP levels upon admission could predict all-cause mortality in IE patients undergoing cardiac surgery.

Novel putative biomarkers for infective endocarditis by serum proteomic analysis: a comprehensive review of literature

Infective endocarditis (IE) is a challenging condition with high mortality. Prompt detection of IE has become essential for early and immediate management. The authors aimed to comprehensively review the existing literature on novel putative biomarkers for IE through serum proteomic analysis. The literature reveals high levels of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) levels in IE with staphylococcal etiology, valvular lesions, and when combined with cardiac troponin I (cTnI), had a more significant value for risk stratification. A higher pro-ADM level, copeptin, NT-proBNP, and the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) all impacted mortality during the hospital stay. The biomarker matrix metalloproteinase-9 was utilized to predict new-onset embolic events in patients, thus serving as a predictive marker. Procalcitonin was an important diagnostic marker in IE complicated with severe infection. Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interferon-γ, cTnI, and NT-proBNP were also discovered to be useful as prognostic indicators. Early diagnosis and appropriate treatment are possible using antiphospholipid antibodies as a diagnostic test for definite IE. It is also concluded that antineutrophilic cytoplasmic antibody positive individuals with IE had a lengthier hospital stay. These noninvasive biomarkers can identify patients at risk and provide appropriate and early clinical management. NT-proBNP, Cystatin C, troponins, IL-6, IL-8, S100A11, and AQP9 are examples of possible markers that appear promising for further research. In conclusion, large-scale validation studies should study these biomarkers further to establish their use in clinical settings.

Infective Endocarditis: Predictive Factors for Diagnosis and Mortality in Surgically Treated Patients

Background: Diagnosis of infective endocarditis (IE) often is challenging, and mortality is high in such patients. Our goal was to characterize common diagnostic tools to enable a rapid and accurate diagnosis and to correlate these tools with mortality outcomes. Methods: Because of the possibility of including perioperative diagnostics, only surgically treated patients with suspected left-sided IE were included in this retrospective, monocentric study. A clinical committee confirmed the diagnosis of IE. Results: 201 consecutive patients (age 64 ± 13 years, 74% male) were finally diagnosed with IE, and 14 patients turned out IE-negative. Preoperative tests with the highest sensitivity for IE were positive blood cultures (89.0%) and transesophageal echocardiography (87.5%). In receiver operating characteristics, vegetation size revealed high predictive power for IE (AUC 0.800, p < 0.001) with an optimal cut-off value of 11.5 mm. Systemic embolism was associated with mortality, and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) had predictive power for mortality. Conclusion: If diagnostic standard tools remain inconclusive, we suggest employing novel cut-off values to increase diagnostic accuracy and accelerate diagnosis. Patients with embolism or elevated NT-proBNP deserve a closer follow-up.