Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Claudio Querido Fortes¹  Athanasios Skoutelis²  Andrew Wang³  Javier Gonzalez⁴  Lawrence P. Park⁵  Vivian H. Chu⁵  Gilbert Habib⁶  Orathai Pachirat⁷  Emilio Bouza⁸  Souha Kanj⁹  Jameela Edathodu^1,10  Pierre Tattevin^1,11  Tatjana Lejko‐Zupa^1,12  Javier Altclas^1,13  Ren Tan^1,14  Gail Peterson^1,15  Rinaldo Focaccia Siciliano^1,16 

[1] Research Center, Riyadh, Saudi Arabia;5th Department of Medicine and Infectious Diseases Unit, “Evangelismos” General Hospital, Athens, Greece;American University of Beirut Medical Center, Beirut, Lebanon;Clinica Cardio VID, Medellín, Colombia;Duke University Medical Center, Durham, NC;Faculté de Médecine de Marseille, Marseille, France;Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil;Hospital General Universitario Gregorio Marañón, Madrid, Spain;Khon Kaen University, Khon Kaen, Thailand;;King Faisal Specialist Hospital &Maladies Infectieuses et Réanimation Médicale, Rennes, France;Medical Centre Ljublijana, Ljublijana, Slovenia;Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina;The Canberra Hospital, Woden, Australia;UT‐Southwestern Medical Center, Dallas, TX;Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil;

关键词: infection;    mortality;    prognosis;    surgery;    valves;   

DOI  :  10.1161/JAHA.115.003016

来源: DOAJ

【 摘 要 】

BackgroundHost factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in IE. Methods and ResultsUsing a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]–Prospective Cohort Study [PCS], 2000–2006, n=4049), a model to predict 6‐month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE‐PLUS, 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the ICE‐PCS cohort and 342 of 1197 (28.6%) in the ICE‐PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left‐sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6‐month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62–0.89). A simplified risk model was developed by weight adjustment of these variables. ConclusionsSix‐month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.

【 授权许可】

Unknown