Índice de risco de mortalidade por endocardite infecciosa: um modelo logístico multivariado

Costa, Mário Augusto Cray da; Wollmann, Darley Rugery; Campos, Antonio Carlos Ligoski; Cunha, Cristiane Martins; Carvalho, Roberto Gomes de; Andrade, Dalton Francisco de; Loures, Danton Richilin Rocha

doi:10.1590/s0102-76382007000200007

Cited by 24 publications

(15 citation statements)

References 22 publications

(49 reference statements)

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“…The overall mortality rate in these patients was 18%, which was in agreement with other mortality rates reported between 13% and 40% [7], [17], [23], [34]. We obtained a low rate of postoperative complications (2.9%) during dental preparation.…”

Section: Discussionsupporting

confidence: 90%

Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis?

Souza

Rocha

Castro

et al. 2016

IJC Heart & Vasculature

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BackgroundInfective endocarditis (IE) is a serious disease that affects the surface of the endocardium. The spread of microorganisms from the oral cavity has been associated with the occurrence of IE.ObjectiveTo analyze whether dental treatment before cardiac valve surgery (CVS) influenced the occurrence of IE.MethodsWe performed a retrospective analysis of the medical and dental histories of patients undergoing CVS from 2004 to 2014. The sample consisted of 481 patients who underwent CVS divided into two groups: patients submitted to dental treatment prior to CVS (n = 110) and patients undergoing CVS without dental treatment (n = 371).ResultsOf the total sample, 38 patients (8%) were diagnosed with IE. No significant difference was detected (p = 0.496) in comparing the occurrence of IE in the group with dental preparation (6.4%) and without dental preparation (8.4%). The logistic regression model confirmed that dental treatment did not change the IE risk (p = 0.504) and indicated that age (p < 0.003) and gender (p = 0.013) were significant risk factors for IE. There was a high demand for dental procedures in the group receiving dental preparation, with no significant differences between the patients with or without IE. Hemoculture indicated qualitative differences in comparing patients with and without dental treatment, especially in the frequency of Staphylococcus and Streptococcus.ConclusionsThe results did not allow for the determination of the impact of dental treatment before CVS on IE outcomes. However, it was not possible to exclude the potential beneficial effects of dental treatment in the prevention of IE.

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Section: Discussionsupporting

confidence: 90%

Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis?

Souza

Rocha

Castro

et al. 2016

IJC Heart & Vasculature

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“…The present study, consistently with a number of previous analyses [12–15], showed that 2 out of the 6 most significant independent predictors of postoperative death in 440 endocarditis surgery patients were specific of the IE setting, that is, microbiology- or infection-related, and not included in the most commonly employed prognostic systems. …”

Section: Discussionsupporting

confidence: 89%

“…Until recently, only a small Brazilian study including 186 patients had tried to derive a score system from a mixed native and prosthetic endocarditis cohort [12]: single-center design and small numbers prevent direct wider applicability of that system, as well as ours. The aforementioned Duke's study by Gaca and colleagues, conversely, was based on more than 13,600 IE patients from the STS database [9]: the multicentric design and the large sample size provided optimal statistical strength and applicability at least over all North America.…”

Section: Discussionmentioning

confidence: 99%

“…The aforementioned Duke's study by Gaca and colleagues, conversely, was based on more than 13,600 IE patients from the STS database [9]: the multicentric design and the large sample size provided optimal statistical strength and applicability at least over all North America. However, STS entries do not include microbiological (cultures, species) and anatomical (vegetations, abscess) data, which; however, play an important prognostic role [12–15]. Moreover, the Duke study considered native and prosthetic valve IE together [9], whereas prosthetic valve endocarditis is a definitely distinct condition, with a considerably higher mortality and, even more importantly when prognostic stratification is concerned, with markedly different preoperative features [10].…”

Section: Discussionmentioning

confidence: 99%

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The Need for a Specific Risk Prediction System in Native Valve Infective Endocarditis Surgery

Feo

Cotrufo²,

Carozza³

et al. 2012

The Scientific World Journal

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The need for a specific risk score system for infective endocarditis (IE) surgery has been previously claimed. In a single-center pilot study, preliminary to future multicentric development and validation, bivariate and multivariate (logistic regression) analysis of early postoperative mortality predictors in 440 native valve IE patients were performed. Mathematical procedures assigned scores to the independent predictors emerged (AUC of the ROC curve: 0.88). Overall mortality was 9.1%. Six predictors were identified and assigned scores, including age (5–13 points), renal failure (5), NYHA class IV (9), critical preoperative state (11), lack of preoperative attainment of blood culture negativity (5), perivalvular involvement (5). Four risk classes were drawn ranging from “very low risk” (≤5 points, mean predicted mortality 1%), and to “very high risk” (≥20 points, 43% mortality). IE-specific risk stratification models are both needed, as disease-specific factors (e.g., cultures, abscess), beside the generic ones (e.g., age, renal impairment) affect mortality, and feasible.

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“…Costa et al demonstrated that summation of clinical and echocardiographic scores as the predictors of mortality included: age over 40 years (4 points), New York Heart Association (NYHA) class-IV heart failure or cardiovascular shock (5 points), uncontrolled sepsis (6 points), conduction disorder (5 points), arrhythmia (8 points), a valve with extensive damage or abscess, or a prosthesis (5 points), large and mobile vegetation (4 points) [14]. Mortality rates for scores below 10 were 5.26% and for scores over 20 were and 78.9%.…”

Section: Discussionmentioning

confidence: 99%

Dev mitral kapak vejetasyonu

Tigen¹,

Bilgin²,

Özben³

et al. 2014

Marmara Medical Journal

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We present a case of giant mitral valve vegetation in a 66-year-old woman whose clinical status deteriorated rapidly without allowing time for surgery. She died due to a septic embolism and multiorgan failure. Our aim is to stress that the risk of embolic complications is high in cases of large vegetations. The mortality rates are high and these patients should be managed immediately. Keywords: Giant vegetation, Infective endocarditis, Septic embolism ÖZETBiz burada klinik durumu cerrahi müdahaleye fırsat vermeden kötüleşen ve septik emboli ve çoklu organ yetmezliğine bağlı ölen 66 yaşında mitral kapakta dev vejetasyonu olan bayan hastayı sunuyoruz. Amacımız büyük vejetasyonları olan vakalarda embolik komplikasyon riskinin ve mortalite oranlarının yüksek olduğunu, çok hızlı müdahale edilmesi gerektiğini vurgulamaktır.

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Índice de risco de mortalidade por endocardite infecciosa: um modelo logístico multivariado

Abstract: The higher the score, the higher the mortality rate. The mortality risk index may be used to estimate mortality in Infective Endocarditis.

Cited by 24 publications

References 22 publications

Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis?

Dental care before cardiac valve surgery: Is it important to prevent infective endocarditis?

The Need for a Specific Risk Prediction System in Native Valve Infective Endocarditis Surgery

Dev mitral kapak vejetasyonu

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