Prediction of Symptomatic Embolism in Infective Endocarditis

被引:124
作者
Hubert, Sandrine [1 ,2 ]
Thuny, Franck [1 ,3 ,4 ]
Resseguier, Noemie [5 ,6 ]
Giorgi, Roch [5 ,6 ]
Tribouilloy, Christophe [7 ,8 ]
Le Dolley, Yvan [1 ]
Casalta, Jean-Paul [9 ]
Riberi, Alberto [2 ]
Chevalier, Florent [7 ]
Rusinaru, Dan [7 ]
Malaquin, Dorothee [7 ]
Remadi, Jean Paul [10 ]
Ben Ammar, Ammar [11 ]
Avierinos, Jean Francois [1 ]
Collart, Frederic [2 ]
Raoult, Didier [3 ,9 ]
Habib, Gilbert [1 ]
机构
[1] Aix Marseille Univ, Assistance Publ Hop Marseille, Hop Univ Timone, Dept Cardiol, F-13005 Marseille, France
[2] Aix Marseille Univ, Assistance Publ Hop Marseille, Hop Univ Timone, Serv Chirurg Cardiaque, F-13005 Marseille, France
[3] Aix Marseille Univ, Inserm 1095, IRD 198, CNRS 7278,UM63,URMITE, F-13005 Marseille, France
[4] Aix Marseille Univ, Assistance Publ Hop Marseille, Hop Univ Nord, Dept Cardiol, F-13005 Marseille, France
[5] Aix Marseille Univ, Fac Med, LERTIM, F-13005 Marseille, France
[6] Aix Marseille Univ, Fac Med, UMR INSERM IRD 912, F-13005 Marseille, France
[7] Hop Univ Sud, Dept Cardiol, Amiens, France
[8] INSERM, ERI 12, Amiens, France
[9] Aix Marseille Univ, Assistance Publ Hop Marseille, Hop Timone, Ctr Hosp Univ,Lab Microbiol, F-13005 Marseille, France
[10] Hop Univ Sud, Dept Chirurg Cardiaque, Amiens, France
[11] Hop Univ Sud, Dept Anesthesie, Amiens, France
关键词
embolism; endocarditis; prognosis; CEREBROVASCULAR COMPLICATIONS; PROSPECTIVE MULTICENTER; ANTIMICROBIAL THERAPY; COMPETING RISKS; EARLY SURGERY; EVENTS; ECHOCARDIOGRAPHY; MANAGEMENT; DIAGNOSIS; EMBOLIZATION;
D O I
10.1016/j.jacc.2013.07.029
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives The aim of this study was to develop and validate a simple calculator to quantify the embolic risk (ER) at admission of patients with infective endocarditis. Background Early valve surgery reduces the incidence of embolism in high-risk patients with endocarditis, but the quantification of ER remains challenging. Methods From 1,022 consecutive patients presenting with definite diagnoses of infective endocarditis in a multicenter observational cohort study, 847 were randomized into derivation (n = 565) and validation (n = 282) samples. Clinical, microbiological, and echocardiographic data were collected at admission. The primary endpoint was symptomatic embolism that occurred during the 6-month period after the initiation of treatment. The prediction model was developed and validated accounting for competing risks. Results The 6-month incidence of embolism was similar in the development and validation samples (8.5% in the 2 samples). Six variables were associated with ER and were used to create the calculator: age, diabetes, atrial fibrillation, embolism before antibiotics, vegetation length, and Staphylococcus aureus infection. There was an excellent correlation between the predicted and observed ER in both the development and validation samples. The C-statistics for the development and validation samples were 0.72 and 0.65, respectively. Finally, a significantly higher cumulative incidence of embolic events was observed in patients with high predicted ER in both the development (p < 0.0001) and validation (p < 0.05) samples. Conclusions The risk for embolism during infective endocarditis can be quantified at admission using a simple and accurate calculator. It might be useful for facilitating therapeutic decisions. (C) 2013 by the American College of Cardiology Foundation
引用
收藏
页码:1384 / 1392
页数:9
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