Predictors of In-Hospital Mortality From Infective Endocarditis in a Resource-Limited, War-Affected Tertiary Center.

Background: Infective endocarditis (IE) carries a high in-hospital mortality, particularly in resource-limited and war-affected settings. However, data on short-term mortality predictors in such environments remain limited. Therefore, this study aimed to identify independent predictors of in-hospital mortality among patients with IE treated at a tertiary referral center in Yemen. Methods: A prospective cohort study was conducted between October 2023 and August 2025 at the largest tertiary referral center in Yemen. A total of 60 consecutive patients with IE (46 with definite IE and 14 with possible IE) were included, diagnosed according to the modified Duke criteria. Candidate predictors were screened using univariable analyses. Given the limited number of outcome events, the least absolute shrinkage and selection operator (LASSO) regression was applied for variable selection, followed by Firth's penalized logistic regression to obtain bias-reduced estimates. Results: A total of 17 patients died during hospitalization, yielding an in-hospital mortality rate of 28.3%. Baseline demographic characteristics, microbiological findings, and most echocardiographic parameters were not independently associated with mortality. However, in-hospital complications showed strong associations with death. In the final penalized multivariable model, septic shock (adjusted odds ratio (AOR) 14.441; 95% confidence interval (CI): 2.242-176.650; Conclusions: In this war-affected and resource-limited setting, in-hospital mortality from IE was substantial and driven primarily by severe systemic complications. Early recognition and aggressive management of septic shock and AKI may improve short-term outcomes in similar low-resource environments.