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Validated risk score for predicting 6-month mortality in infective endocarditis

Journal article
Authors Lawrence P. Park
Vivian H. Chu
Gail Peterson
Athanasios Skoutelis
Tatjana Lejko-Zupa
Emilio Bouza
Pierre Tattevin
Gilbert Habib
Ren Tan
Javier Gonzalez
Javier Altclas
Jameela Edathodu
Claudio Querido Fortes
Rinaldo Focaccia Siciliano
Orathai Pachirat
Souha Kanj
Andrew Wang
Liliana Clara
Marisa LSanchez
José Casabé
Claudia Cortes
Francisco Nacinovich
Pablo Fernandez Oses
Ricardo Ronderos
Adriana Sucari
Jorge Thierer
Denis Spelman
Eugene Athan
Owen Harris
Karina Kennedy
Ren Tan
David Gordon
Lito Papanicolas
Tony Korman
Despina Kotsanas
Robyn Dever
Phillip Jones
Pam Konecny
Richard Lawrence
David Rees
Suzanne Ryan
Michael P. Feneley
John Harkness
Phillip Jones
Suzanne Ryan
Phillip Jones
Suzanne Ryan
Phillip Jones
Jeffrey Post
Porl Reinbott
Suzanne Ryan
Rainer Gattringer
Franz Wiesbauer
Adriana Ribas Andrade
Ana Cláudia Passos de Brito
Armenio Costa Guimarães
Regina Aparecida de Medeiros Tranchesi
Marcelo Goulart Paiva
Auristela de Oliveira Ramos
Clara Weksler
Giovanna Ferraiuoli
Wilma Golebiovski
Cristiane Lamas
A. Karlowsky James
Yoav Keynan
Andrew M. Morris
Ethan Rubinstein
Sandra Braun Jones
Patricia Garcia
M. Cereceda
Alberto Fica
Rodrigo Montagna Mella
Ricardo Fernandez
Liliana Franco
Javier Gonzalez
Astrid Natalia Jaramillo
Bruno Barsic
Suzana Bukovski
Vladimir Krajinovic
Ana Pangercic
Igor Rudez
Josip Vincelj
Tomas Freiberger
Jiri Pol
Barbora Zaloudikova
Zainab Ashour
Amani El Kholy
Marwa Mishaal
Dina Osama
Hussien Rizk
Neijla Aissa
Corentine Alauzet
Francois Alla
Chu Catherine Campagnac
Thanh Doco-Lecompte
Christine Selton-Suty
Francois Delahaye
Armelle Delahaye
Francois Vandenesch
Lars Olaison
Published in Journal of the American Heart Association
Volume 5
Issue 4
Publication year 2016
Published at
Language en
Links https://doi.org/10.1161/JAHA.115.00...
Keywords Infection, Mortality, Prognosis, Surgery, Valves
Subject categories Infectious Medicine

Abstract

© 2016 The Authors. 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.

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