Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis.

September 28, 2016 at 8:32 am

J Am Heart Assoc. 2016 Apr 18;5(4):e003016.

Park LP, Chu VH, Peterson G, Skoutelis A, Lejko-Zupa T, Bouza E, Tattevin P, Habib G, Tan R, Gonzalez J, Altclas J, Edathodu J, Fortes CQ, Siciliano RF, Pachirat O, Kanj S, Wang A; International Collaboration on Endocarditis (ICE) Investigators.

Collaborators (306)

Clara L, Sanchez M, Casabé J, Cortes C, Nacinovich F, Fernandez Oses P, Ronderos R, Sucari A, Thierer J, Kogan S, Spelman D, Athan E, Harris O, Kennedy K, Gordon D, Papanicolas L, Korman T, Kotsanas D, Dever R, Jones P, Konecny P, Lawrence R, Rees D, Ryan S, Feneley MP, Harkness J, Jones P, Ryan S, Jones P, Ryan S, Jones P, Post J, Reinbott P, Ryan S, Gattringer R, Wiesbauer F, Andrade AR, de Brito AC, Guimarães AC, Grinberg M, Mansur AJ, Strabelli TM, Vieira ML, de Medeiros Tranchesi RA, Paiva MG, de Oliveira Ramos A, Weksler C, Ferraiuoli G, Golebiovski W, Lamas C, Karlowsky JA, Keynan Y, Morris AM, Rubinstein E, Jones SB, Garcia P, Fica A, Mella RM, Fernandez R, Franco L, Jaramillo AN, Barsic B, Bukovski S, Krajinovic V, Pangercic A, Rudez I, Vincelj J, Freiberger T, Pol J, Zaloudikova B, Ashour Z, El Kholy A, Mishaal M, Osama D, Rizk H, Aissa N, Alauzet C, Alla F, Campagnac C, Doco-Lecompte T, Selton-Suty C, Casalta JP, Fournier PE, Raoult D, Thuny F, Delahaye F, Delahaye A, Vandenesch F, Donal E, Donnio PY, Flecher E, Michelet C, Revest M, Chevalier F, Jeu A, Rémadi JP, Rusinaru D, Tribouilloy C, Bernard Y, Chirouze C, Hoen B, Leroy J, Plesiat P, Naber C, Neuerburg C, Mazaheri B, Naber C, Neuerburg C, Athanasia S, Deliolanis I, Giamarellou H, Thomas T, Giannitsioti E, Mylona E, Paniara O, Papanicolaou K, Pyros J, Mylona E, Paniara O, Papanikolaou K, Pyros J, Sharma G, Francis J, Nair L, Thomas V, Venugopal K, Hannan MM, Hurley JP, Cahan A, Gilon D, Israel S, Korem M, Strahilevitz J, Rubinstein E, Strahilevitz J, Durante-Mangoni E, Mattucci I, Pinto D, Agrusta F, Senese A, Ragone E, Utili R, Cecchi E, De Rosa F, Forno D, Imazio M, Trinchero R, Grossi P, Lattanzio M, Toniolo A, Goglio A, Raglio A, Ravasio V, Rizzi M, Suter F, Carosi G, Magri S, Signorini L, Kanafani Z, Kanj SS, Sharif-Yakan A, Abidin I, Tamin SS, Martínez ER, Soto Nieto GI, van der Meer JT, Chambers S, Holland D, Morris A, Raymond N, Read K, Murdoch DR, Dragulescu S, Ionac A, Mornos C, Butkevich OM, Chipigina N, Kirill O, Vadim K, Vinogradova T, Halim M, Liew YY, Tan RS, Logar M, Mueller-Premru M, Commerford P, Commerford A, Deetlefs E, Hansa C, Ntsekhe M, Almela M, Armero Y, Azqueta M, Castañeda X, Cervera C, Falces C, Garcia-de-la-Maria C, Fita G, Gatell JM, Heras M, Llopis J, Marco F, Mestres CA, Miró JM, Moreno A, Ninot S, Paré C, Pericas JM, Ramirez J, Rovira I, Sitges M, Anguera I, Font B, Guma JR, Bermejo J, Garcia Fernández MA, Gonzalez-Ramallo V, Marín M, Muñoz P, Pedromingo M, Roda J, Rodríguez-Créixems M, Solis J, Almirante B, Fernandez-Hidalgo N, Tornos P, de Alarcón A, Parra R, Alestig E, Johansson M, Olaison L, Snygg-Martin U, Pachirat P, Pussadhamma B, Senthong V, Casey A, Elliott T, Lambert P, Watkin R, Eyton C, Klein JL, Bradley S, Kauffman C, Bedimo R, Corey GR, Crowley AL, Douglas P, Drew L, Fowler VG, Holland T, Lalani T, Mudrick D, Samad Z, Sexton D, Stryjewski M, Woods CW, Lerakis S, Cantey R, Steed L, Wray D, Dickerman SA, Bonilla H, DiPersio J, Salstrom SJ, Baddley J, Patel M, Stancoven A, Levine D, Riddle J, Rybak M, Cabell CH, Baloch K, Corey GR, Dixon CC, Fowler VG Jr, Harding T, Jones-Richmond M, Sanderford B, Sanderford B, Stafford J, Stafford J, Anstrom K, Athan E, Bayer AS, Cabell CH, Corey GR, Fowler VG Jr, Hoen B, Karchmer AW, Miró JM, Murdoch DR, Sexton DJ, Bayer AS, Cabell CH, Chu V, Corey GR, Durack DT, Eykyn S, Fowler VG Jr, Hoen B, Miró JM, Moreillon P, Olaison L, Raoult D, Rubinstein E, Sexton DJ.

Abstract

BACKGROUND:

Host 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 RESULTS:

Using 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.

CONCLUSIONS:

Six-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.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859286/pdf/JAH3-5-e003016.pdf

Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, Epidemiología, F.O.D, Infecciones cardio-vasculares, Metodos diagnosticos, Resistencia bacteriana, Sepsis, Update. Tags: .

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