The geriatric syndromes in elderly patients with infective endocarditis: impact on in-hospital mortality

The geriatric syndromes in elderly patients with infective endocarditis: impact on in-hospital mortality

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Maria Fernandez-Regueras¹, Patricia Muñoz García², Ane Josune Goikoetxea Agirre³, Mª José Blanco Vidal³, Mikel del Alamo Martínez de Lagos³, Miguel Ángel Goenaga Sánchez⁴, María Jesús Bustinduy Odriozola⁴, Xabier Camino Barrón⁴, Martha Kestler Hernández⁵, Andrea Kallmeyer Mayor⁶, Manuel Martínez-Sellés⁷, Jose-Angel Perez-Rivera⁸^,^✉, The researchers from the GAMES cohort are listed as collaborators. The full list of collaborators is provided in the Appendix.

Journal of Geriatric Cardiology | 2026, 23(9) : 565 - 575

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Journal of Geriatric Cardiology | 2026, 23(9): 565-575

• RESEARCH ARTICLE •

The geriatric syndromes in elderly patients with infective endocarditis: impact on in-hospital mortality

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Affiliations

^1.Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario de Burgos, Instituto de Investigación Biosanitaria de Burgos (IBioBurgos), Spain

^2.Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Faculty of Medicine, Universidad Complutense de Madrid, Spain

^3.Department of Infectious Diseases, Hospital Universitario de Cruces, Bilbao, Spain

^4.ⅡS Biogipuzkoa, Infectious Diseases Area, Research Group on Infectious Diseases and Global Health; Osakidetza, Hospital Universitario Donostia, Department of Infectious Diseases, San Sebastián, Spain

^5.Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Faculty of Medicine, Universidad Complutense de Madrid, Spain

^6.Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

^7.Cardiology Department, Hospital General, Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, School of Biomedical Sciences and Health, Universidad Europea, School of Medicine, Universidad Complutense, Madrid, Spain

^8.Department of Cardiology, Hospital Universitario de Burgos, Instituto de Investigación Biosanitaria de Burgos (IBioBurgos), Faculty of Health Sciences, Universidad Isabel I, Burgos, Spain

Published: 2026-09-28 doi: 10.26599/1671-5411.2026.09.006

Outline

Abstract

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Background

Infective endocarditis (IE) is associated with high morbidity and mortality. However, the impact of geriatric syndromes on clinical outcomes in elderly patients with IE remains insufficiently characterized. The aim was to assess the prevalence of geriatric syndromes; focusing on frailty, functional dependence, comorbidity and malnutrition; and their association with in-hospital mortality in advanced-age patients with infective endocarditis.

Methods

This prospective multicenter observational registry included patients aged ≥ 75 years with possible or definitive IE. Comprehensive geriatric assessment was performed after IE diagnosis using the Clinical Frailty Scale (CFS), FRAIL scale, Mini Nutritional Assessment Short Form (MNA-SF), Barthel index, and age-adjusted Charlson comorbidity index. Patients were classified as frail (CFS ≥ 4) or non-frail (CFS < 4).

Results

Among 115 patients (median age 81 [78-85] years, 70.4% male), 52 (45.2%) were classified as frail. Despite similar surgical indications, frail patients underwent surgery less frequently than non-frail patients (10 (19.2%) vs. 30 (47.6%), P = 0.001) and presented higher in-hospital mortality (19 (36.5%) vs. 10 (15.9%), P = 0.011). Multivariate analysis identified malnutrition risk (MNA-SF: OR = 0.712, 95% CI: 0.516-0.983, P = 0.039) and comorbidity (adjusted Charlson: OR = 1.623, 95% CI: 1.108-2.379, P = 0.013) as independent predictors of in-hospital mortality. Frailty was significantly associated with mortality in a separate model excluding malnutrition, suggesting overlap between both constructs.

Conclusions

Geriatric syndromes, particularly comorbidity and malnutrition, are highly prevalent in elderly patients with IE and independently predict in-hospital mortality. Comprehensive geriatric assessment should be integrated into clinical decision-making for this population.

Cite this Article

Maria Fernandez-Regueras, Patricia Muñoz García, Ane Josune Goikoetxea Agirre, Mª José Blanco Vidal, Mikel del Alamo Martínez de Lagos, Miguel Ángel Goenaga Sánchez, María Jesús Bustinduy Odriozola, Xabier Camino Barrón, Martha Kestler Hernández, Andrea Kallmeyer Mayor, Manuel Martínez-Sellés, Jose-Angel Perez-Rivera, The researchers from the GAMES cohort are listed as collaborators. The full list of collaborators is provided in the Appendix.. The geriatric syndromes in elderly patients with infective endocarditis: impact on in-hospital mortality. 老年心脏病杂志（英文）, 2026 , 23 (9) : 565 -575 . DOI: 10.26599/1671-5411.2026.09.006

Maria Fernandez-Regueras, Patricia Muñoz García, Ane Josune Goikoetxea Agirre, Mª José Blanco Vidal, Mikel del Alamo Martínez de Lagos, Miguel Ángel Goenaga Sánchez, María Jesús Bustinduy Odriozola, Xabier Camino Barrón, Martha Kestler Hernández, Andrea Kallmeyer Mayor, Manuel Martínez-Sellés, Jose-Angel Perez-Rivera, The researchers from the GAMES cohort are listed as collaborators. The full list of collaborators is provided in the Appendix.. The geriatric syndromes in elderly patients with infective endocarditis: impact on in-hospital mortality[J]. Journal of Geriatric Cardiology, 2026 , 23 (9) : 565 -575 . DOI: 10.26599/1671-5411.2026.09.006

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References

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[1]

Ambrosioni J, Hernández-Meneses M, Durante-Mangoni E, et al. Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000-2012). Infect Dis Ther 2023; 12: 1083-1101.

[2]

Muñoz P, Kestler M, De Alarcon A, et al. Current epidemiology and outcome of infective endocarditis: a multicenter, prospective, cohort study. Medicine (Baltimore) 2015; 94: e1816.

[3]

Armiñanzas C, Fariñas-Alvarez C, Zarauza J, et al. Role of age and comorbidities in mortality of patients with infective endocarditis. Eur J Intern Med 2019; 64: 63-71.

[4]

Bea C, Vela S, García-Blas S, et al. Infective Endocarditis in the Elderly: Challenges and Strategies. J Cardiovasc Dev Dis. 2022; 9: 192.

[5]

Perez-Rivera J-A, Armiñanzas C, Muñoz P, et al. Comorbidity and Prognosis in Octogenarians with Infective Endocarditis. J Clin Med. 2022; 11: 3774.

[6]

Forestier E, Roubaud-Baudron C, Fraisse T, et al. Comprehensive geriatric assessment in older patients suffering from infective endocarditis. A prospective multicentric cohort study. Clin Microbiol Infect 2019; 25: 1246-1252.

[7]

Díez-Villanueva P, Arizá-Solé A, Vidán MT, et al. Recommendations of the Geriatric Cardiology Section of the Spanish Society of Cardiology for the Assessment of Frailty in Elderly Patients With Heart Disease. Rev Esp Cardiol (Engl Ed) 2019; 72: 63-71.

[8]

Kim DH, Rockwood K. Frailty in Older Adults. N Engl J Med 2024; 391: 538-548.

[9]

Graversen PL, Østergaard L, Smerup MH, et al. Surgery in patients with infective endocarditis and prognostic importance of patient frailty. Infection 2024; 52: 1953-1963.

[10]

Diaz-Arocutipa C, Moreno G, Vicent L. Impact of valvular surgery according to frailty risk in patients with infective endocarditis. Clin Cardiol 2024; 47: e24268.

[11]

Saito Y, Aizawa Y, Iida K, et al. Clinical Significance of the Controlling Nutritional Status (CONUT) Score in Patients with Infective Endocarditis. Int Heart J 2020; 61: 531-538.

[12]

Lu KJ, Kearney LG, Ord M, et al. Age adjusted Charlson Co-morbidity Index is an independent predictor of mortality over long-term follow-up in infective endocarditis. Int J Cardiol 2013; 168: 5243-5248.

[13]

Pérez-García CN, Olmos C, García-Arribas D, et al. Frailty predicts in-hospital and 1-year outcomes in patients with infective endocarditis. Clin Microbiol Infect 2026; 32: 118-127.

[14]

Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44: 3948-4042.

[15]

Abellan van Kan G, Rolland YM, Morley JE, Vellas B. Frailty: toward a clinical definition. J Am Med Dir Assoc 2008; 9: 71-72.

[16]

Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495.

[17]

Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56: M366-M372.

[18]

Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J 1965; 14: 61-65.

[19]

Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40: 373-383.

[20]

Pazdernik M, Iung B, Mutlu B, et al. Surgery and out-come of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry. Infection 2022; 50: 1191-1202.

[21]

Medeiros MMD de, Figueredo OMC de, Pinheiro MA, et al. Factors associated with the overlap of frailty and nutrition in institutionalized older adults: A multicenter study. Arch Gerontol Geriatr 2020; 90: 104150.

[22]

Abe T, Jujo K, Fujimoto Y, et al. Overlap of frailty and malnutrition as prognosticators in older patients with heart failure. Am Heart J Plus. 2024; 46: 100467.

[23]

Ligthart-Melis GC, Luiking YC, Kakourou A, et al. Frailty, Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020; 21: 1216-1228.

[24]

Arosio B, Ferri E, Mari D, et al. The influence of inflammation and frailty in the aging continuum. Mech Ageing Dev 2023; 215: 111872.

[25]

Esteban-Fernández A, Villar-Taibo R, Alejo M, et al. Diagnosis and management of malnutrition in patients with heart failure. JCM 2023; 12: 3320.

[26]

Jiménez-Méndez C, Díez-Villanueva P, Bonanad C, et al. Fragilidad y pronóstico de los pacientes mayores con insuficiencia cardiaca. Revista Españ ola de Cardiología 2022; 75: 1011-1019.

[27]

Martínez-Sellés M, Muñoz P, Arnáiz A, et al. Valve surgery in active infective endocarditis: A simple score to predict in-hospital prognosis. Int J Cardiol 2014; 175: 133-137.

[28]

Fernández-Hidalgo N, Ferreria-González I, Marsal JR, et al. A pragmatic approach for mortality prediction after surgery in infective endocarditis: optimizing and refining EuroSCORE. Clin Microbiol Infect 2018; 24: 1102. e7-1102. e15.

[29]

Bonilla-Palomas JL, Gámez-López AL, Castillo-Domínguez JC, et al. Nutritional Intervention in Malnourished Hospitalized Patients with Heart Failure. Arch Med Res 2016; 47: 535-540.

[30]

Kitzman DW, Whellan DJ, Duncan P, et al. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med 2021; 385: 203-216.

Appendix

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Year 2026 volume 23 Issue 9

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Article Info

doi: 10.26599/1671-5411.2026.09.006

Online Date：2026-10-30
Published：2026-09-28

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Affiliations

^1.Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario de Burgos, Instituto de Investigación Biosanitaria de Burgos (IBioBurgos), Spain

^3.Department of Infectious Diseases, Hospital Universitario de Cruces, Bilbao, Spain

^6.Department of Cardiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

^8.Department of Cardiology, Hospital Universitario de Burgos, Instituto de Investigación Biosanitaria de Burgos (IBioBurgos), Faculty of Health Sciences, Universidad Isabel I, Burgos, Spain

Corresponding:

^✉ japerezr@saludcastillayleon.es

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表12种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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