Excess mortality and morbidity in patients surviving infective endocarditis

Thuny, Franck; Giorgi, Roch; Habachi, Raja; Ansaldi, Sébastien; Dolley, Yvan Le; Casalta, Jean‐Paul; Avierinos, Jean-François; Ribéri, Alberto; Renard, Sébastien; Collart, Frédéric; Raoult, Didier; Habib, Gilbert

doi:10.1016/j.ahj.2012.04.003

Cited by 108 publications

(97 citation statements)

References 31 publications

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“…In the ICE‐PCS cohort, in‐hospital mortality was associated with IE complications of prosthetic or mitral valve IE, pulmonary edema, paravalvular complication, and S aureus infection 1. Longer term studies have demonstrated higher mortality rates in IE patients beyond the index hospitalization, predominantly due to noncardiovascular conditions 4, 5. A recent study from Taiwan using administrative claims also found higher risk of cardiovascular events in long‐term follow‐up 5.…”

Section: Discussionmentioning

confidence: 99%

“…Despite improvements in diagnostic testing, antimicrobial treatment, and surgical intervention, changes in the epidemiology of IE, including the rise of health care–associated infection and Staphylococcus aureus as a virulent causative organism,2, 3 increase the risk of complications and death in the acute phase of IE. Furthermore, survival after hospital discharge may be reduced by late complications and comorbid conditions 4, 5…”

Section: Introductionmentioning

confidence: 99%

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

Park

Peterson

Skoutelis

et al. 2016

JAHA

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108

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Park

Peterson

Skoutelis

et al. 2016

JAHA

Self Cite

108

View full text Add to dashboard Cite

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“…No gender differences were present even in the surgery procedures, P=0.9 or in mortality, P=0.2. Since the 80s no significant increase in survival has been reported and nowadays the mortality rate remains high (32) in spite of recent medical and surgical advances. On the contrary, a trend towards an increased mortality has been reported and in recent years (18,32).…”

Section: Discussionmentioning

confidence: 99%

“…Since the 80s no significant increase in survival has been reported and nowadays the mortality rate remains high (32) in spite of recent medical and surgical advances. On the contrary, a trend towards an increased mortality has been reported and in recent years (18,32). The widespread of diagnostic modalities with subsequent greater ease of discovery, population ageing and increase invasiveness of modern medicine may justify the absence of survival improvements and our data seem to confirm this trend.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and mortality trends in infective endocarditis, a 17-year population-based prospective study

Cresti¹,

Chiavarelli²,

Scalese³

et al. 2017

Cardiovasc. Diagn. Ther.

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197

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Background: The population at risk, the clinical and microbiological features of infective endocarditis (IE) have changed. Aim of our study was to evaluate the contemporary epidemiological trends, over a 17-year period in a definite region of Tuscany, Italy, to analyze the clinical outcomes and associated prognostic factors.Methods: From 1 January 1998 to 31 December 2014, all patients with a definite diagnosis of IE were prospectively entered in a data-base. The Health-Care system data-base was interrogated to capture patients who could have been missed. The final dataset derived by the merging of the two data-bases.Results: Incidence rate of IE was 4.6/100,000/y with a significant linear incidence increase. In hospitalized patients the incidence was 1.27/1,000 admissions. Over age 65 incidence rate was 11.7/100,000/y.Male/female ratio was 1.54:1. A temporal trend towards an increase in the mean population age was found (P=0.033). There was an increase in the incidence of Health-care associated IE, P=0.016. The most common microorganisms were staphylococcus aureus (25%) and coagulase-negative staphylococci (22%).In-hospital mortality was 24%. A trend towards an increase in mortality rate was found (P=0.055).Independent predictors of mortality were older age, S. aureus infection, heart failure, septic shock and persistent bacteremia. Conclusions:Our study confirms an increasing mortality trend in IE, although with a borderline significance. Elderly forms are associated with poor prognosis and higher than 1-year mortality rate even in the multivariate analysis. Ageing population, increase in healthcare-associated and staphylococcal infections, may explain the rise of IE incidence and of the mortality trend.

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“…"Grupa IZW" powinna publikować w krajowych i międzynarodowych rejestrach dane dotyczące śmiertelności i zachorowalności we wła-snym ośrodku oraz powinna być objęta programem poprawy jakości, natomiast pacjenci powinni brać udział w programie edukacyjnym 4. Dalszą obserwację chorych należy prowadzić w ramach wizyt ambulatoryjnych z częstością zależną od stanu klinicznego pacjenta (najlepiej w 1., 3., 6., 12. miesiącu od zakończenia hospitalizacji, ponieważ w tym okresie występuje większość niekorzystnych zdarzeń [57])…”

Section: "Grupa Izw" (Endocarditis Team)unclassified