• Medientyp: E-Artikel
  • Titel: Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis
  • Beteiligte: Park, Lawrence P.; Chu, Vivian H.; Peterson, Gail; Skoutelis, Athanasios; Lejko‐Zupa, Tatjana; Bouza, Emilio; Tattevin, Pierre; Habib, Gilbert; Tan, Ren; Gonzalez, Javier; Altclas, Javier; Edathodu, Jameela; Fortes, Claudio Querido; Siciliano, Rinaldo Focaccia; Pachirat, Orathai; Kanj, Souha; Wang, Andrew; Clara, Liliana; Sanchez, Marisa; Casabé, José; Cortes, Claudia; Nacinovich, Francisco; Fernandez Oses, Pablo; Ronderos, Ricardo; [...]
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2016
  • Erschienen in: Journal of the American Heart Association
  • Umfang:
  • Sprache: Englisch
  • DOI: 10.1161/jaha.115.003016
  • ISSN: 2047-9980
  • Schlagwörter: Cardiology and Cardiovascular Medicine
  • Zusammenfassung: <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Host factors and complications have been associated with higher mortality in infective endocarditis ( <jats:styled-content style="fixed-case">IE</jats:styled-content> ). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in <jats:styled-content style="fixed-case">IE</jats:styled-content> . </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> Using a large multinational prospective registry of definite <jats:styled-content style="fixed-case">IE</jats:styled-content> (International Collaboration on Endocarditis [ <jats:styled-content style="fixed-case">ICE</jats:styled-content> ]–Prospective Cohort Study [ <jats:styled-content style="fixed-case">PCS</jats:styled-content> ], 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 ( <jats:styled-content style="fixed-case">ICE</jats:styled-content> ‐ <jats:styled-content style="fixed-case">PLUS</jats:styled-content> , 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the <jats:styled-content style="fixed-case">ICE</jats:styled-content> ‐ <jats:styled-content style="fixed-case">PCS</jats:styled-content> cohort and 342 of 1197 (28.6%) in the <jats:styled-content style="fixed-case">ICE</jats:styled-content> ‐ <jats:styled-content style="fixed-case">PLUS</jats:styled-content> 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), <jats:styled-content style="fixed-case">IE</jats:styled-content> characteristics (prosthetic or nosocomial <jats:styled-content style="fixed-case">IE</jats:styled-content> , causative organism, left‐sided valve vegetation), and <jats:styled-content style="fixed-case">IE</jats:styled-content> 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% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.62–0.89). A simplified risk model was developed by weight adjustment of these variables. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> Six‐month mortality after <jats:styled-content style="fixed-case">IE</jats:styled-content> is ≈25% and is predicted by host factors, <jats:styled-content style="fixed-case">IE</jats:styled-content> characteristics, and <jats:styled-content style="fixed-case">IE</jats:styled-content> 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 <jats:styled-content style="fixed-case">IE</jats:styled-content> . </jats:p> </jats:sec>
  • Beschreibung: <jats:sec xml:lang="en">
    <jats:title>Background</jats:title>
    <jats:p xml:lang="en">
    Host factors and complications have been associated with higher mortality in infective endocarditis (
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    ). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    .
    </jats:p>
    </jats:sec>
    <jats:sec xml:lang="en">
    <jats:title>Methods and Results</jats:title>
    <jats:p xml:lang="en">
    Using a large multinational prospective registry of definite
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    (International Collaboration on Endocarditis [
    <jats:styled-content style="fixed-case">ICE</jats:styled-content>
    ]–Prospective Cohort Study [
    <jats:styled-content style="fixed-case">PCS</jats:styled-content>
    ], 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 (
    <jats:styled-content style="fixed-case">ICE</jats:styled-content>

    <jats:styled-content style="fixed-case">PLUS</jats:styled-content>
    , 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the
    <jats:styled-content style="fixed-case">ICE</jats:styled-content>

    <jats:styled-content style="fixed-case">PCS</jats:styled-content>
    cohort and 342 of 1197 (28.6%) in the
    <jats:styled-content style="fixed-case">ICE</jats:styled-content>

    <jats:styled-content style="fixed-case">PLUS</jats:styled-content>
    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),
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    characteristics (prosthetic or nosocomial
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    , causative organism, left‐sided valve vegetation), and
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    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%
    <jats:styled-content style="fixed-case">CI</jats:styled-content>
    0.62–0.89). A simplified risk model was developed by weight adjustment of these variables.
    </jats:p>
    </jats:sec>
    <jats:sec xml:lang="en">
    <jats:title>Conclusions</jats:title>
    <jats:p xml:lang="en">
    Six‐month mortality after
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    is ≈25% and is predicted by host factors,
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    characteristics, and
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    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
    <jats:styled-content style="fixed-case">IE</jats:styled-content>
    .
    </jats:p>
    </jats:sec>
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