Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort

Background: Despite medical advances, mortality in infective endocarditis (IE) is still very high. Previous studies on prognosis in IE have observed conflicting results. The aim of this study was to identify predictors of in-hospital mortality in a large multicenter cohort of left-sided IE. Methods:...

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Autores: Gálvez Acebal, Juan, Rodríguez-Baño, Jesús, Martínez Marcos, Francisco Javier, Reguera, José M., Plata, Antonio, Ruiz, Josefa, Márquez, Manuel, Lomas Cabezas, José Manuel, Torre Lima, Francisco Javier de la, Hidalgo Tenorio, Carmen, Alarcón, Arístides de, Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2010
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:dnet:idus________::df987573b439fd87005f76c2256fb76c
Acceso en línea:https://hdl.handle.net/11441/184878
https://doi.org/10.1186/1471-2334-10-17
Access Level:acceso abierto
Palabra clave:Septic Shock
Endocarditis
Infective Endocarditis
Prosthetic Valve
Neurologic Manifestation
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spelling Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohortGálvez Acebal, JuanRodríguez-Baño, JesúsMartínez Marcos, Francisco JavierReguera, José M.Plata, AntonioRuiz, JosefaMárquez, ManuelLomas Cabezas, José ManuelTorre Lima, Francisco Javier de laHidalgo Tenorio, CarmenAlarcón, Arístides deGrupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)Septic ShockEndocarditisInfective EndocarditisProsthetic ValveNeurologic ManifestationBackground: Despite medical advances, mortality in infective endocarditis (IE) is still very high. Previous studies on prognosis in IE have observed conflicting results. The aim of this study was to identify predictors of in-hospital mortality in a large multicenter cohort of left-sided IE. Methods: An observational multicenter study was conducted from January 1984 to December 2006 in seven hospitals in Andalusia, Spain. Seven hundred and five left-side IE patients were included. The main outcome measure was in-hospital mortality. Several prognostic factors were analysed by univariate tests and then by multilogistic regression model. Results: The overall mortality was 29.5% (25.5% from 1984 to 1995 and 31.9% from 1996 to 2006; Odds Ratio 1.25; 95% Confidence Interval: 0.97-1.60; p = 0.07). In univariate analysis, age, comorbidity, especially chronic liver disease, prosthetic valve, virulent microorganism such as Staphylococcus aureus, Streptococcus agalactiae and fungi, and complications (septic shock, severe heart failure, renal insufficiency, neurologic manifestations and perivalvular extension) were related with higher mortality. Independent factors for mortality in multivariate analysis were: Charlson comorbidity score (OR: 1.2; 95% CI: 1.1-1.3), prosthetic endocarditis (OR: 1.9; CI: 1.2-3.1), Staphylococcus aureus aetiology (OR: 2.1; CI: 1.3-3.5), severe heart failure (OR: 5.4; CI: 3.3-8.8), neurologic manifestations (OR: 1.9; CI: 1.2-2.9), septic shock (OR: 4.2; CI: 2.3-7.7), perivalvular extension (OR: 2.4; CI: 1.3-4.5) and acute renal failure (OR: 1.69; CI: 1.0-2.6). Conversely, Streptococcus viridans group etiology (OR: 0.4; CI: 0.2-0.7) and surgical treatment (OR: 0.5; CI: 0.3-0.8) were protective factors. Conclusions: Several characteristics of left-sided endocarditis enable selection of a patient group at higher risk of mortality. This group may benefit from more specialised attention in referral centers and should help to identify those patients who might benefit from more aggressive diagnostic and/or therapeutic procedures.BioMed CentralMedicinaGobierno de EspañaInstituto de Salud Carlos IIIEuropean Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER)2010info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/184878https://doi.org/10.1186/1471-2334-10-17reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésBMC Infectious Diseases, 10 (17), 17-23. REIPI RD06/0008https://link.springer.com/article/10.1186/1471-2334-10-17info:eu-repo/semantics/openAccessoai:dnet:idus________::df987573b439fd87005f76c2256fb76c2026-06-17T12:51:07Z
dc.title.none.fl_str_mv Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
title Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
spellingShingle Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
Gálvez Acebal, Juan
Septic Shock
Endocarditis
Infective Endocarditis
Prosthetic Valve
Neurologic Manifestation
title_short Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
title_full Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
title_fullStr Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
title_full_unstemmed Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
title_sort Prognostic factors in left-sided endocarditis: results from the andalusian multicenter cohort
dc.creator.none.fl_str_mv Gálvez Acebal, Juan
Rodríguez-Baño, Jesús
Martínez Marcos, Francisco Javier
Reguera, José M.
Plata, Antonio
Ruiz, Josefa
Márquez, Manuel
Lomas Cabezas, José Manuel
Torre Lima, Francisco Javier de la
Hidalgo Tenorio, Carmen
Alarcón, Arístides de
Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)
author Gálvez Acebal, Juan
author_facet Gálvez Acebal, Juan
Rodríguez-Baño, Jesús
Martínez Marcos, Francisco Javier
Reguera, José M.
Plata, Antonio
Ruiz, Josefa
Márquez, Manuel
Lomas Cabezas, José Manuel
Torre Lima, Francisco Javier de la
Hidalgo Tenorio, Carmen
Alarcón, Arístides de
Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)
author_role author
author2 Rodríguez-Baño, Jesús
Martínez Marcos, Francisco Javier
Reguera, José M.
Plata, Antonio
Ruiz, Josefa
Márquez, Manuel
Lomas Cabezas, José Manuel
Torre Lima, Francisco Javier de la
Hidalgo Tenorio, Carmen
Alarcón, Arístides de
Grupo para el Estudio de las Infecciones Cardiovasculares de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI)
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
Gobierno de España
Instituto de Salud Carlos III
European Commission (EC). Fondo Europeo de Desarrollo Regional (FEDER)
dc.subject.none.fl_str_mv Septic Shock
Endocarditis
Infective Endocarditis
Prosthetic Valve
Neurologic Manifestation
topic Septic Shock
Endocarditis
Infective Endocarditis
Prosthetic Valve
Neurologic Manifestation
description Background: Despite medical advances, mortality in infective endocarditis (IE) is still very high. Previous studies on prognosis in IE have observed conflicting results. The aim of this study was to identify predictors of in-hospital mortality in a large multicenter cohort of left-sided IE. Methods: An observational multicenter study was conducted from January 1984 to December 2006 in seven hospitals in Andalusia, Spain. Seven hundred and five left-side IE patients were included. The main outcome measure was in-hospital mortality. Several prognostic factors were analysed by univariate tests and then by multilogistic regression model. Results: The overall mortality was 29.5% (25.5% from 1984 to 1995 and 31.9% from 1996 to 2006; Odds Ratio 1.25; 95% Confidence Interval: 0.97-1.60; p = 0.07). In univariate analysis, age, comorbidity, especially chronic liver disease, prosthetic valve, virulent microorganism such as Staphylococcus aureus, Streptococcus agalactiae and fungi, and complications (septic shock, severe heart failure, renal insufficiency, neurologic manifestations and perivalvular extension) were related with higher mortality. Independent factors for mortality in multivariate analysis were: Charlson comorbidity score (OR: 1.2; 95% CI: 1.1-1.3), prosthetic endocarditis (OR: 1.9; CI: 1.2-3.1), Staphylococcus aureus aetiology (OR: 2.1; CI: 1.3-3.5), severe heart failure (OR: 5.4; CI: 3.3-8.8), neurologic manifestations (OR: 1.9; CI: 1.2-2.9), septic shock (OR: 4.2; CI: 2.3-7.7), perivalvular extension (OR: 2.4; CI: 1.3-4.5) and acute renal failure (OR: 1.69; CI: 1.0-2.6). Conversely, Streptococcus viridans group etiology (OR: 0.4; CI: 0.2-0.7) and surgical treatment (OR: 0.5; CI: 0.3-0.8) were protective factors. Conclusions: Several characteristics of left-sided endocarditis enable selection of a patient group at higher risk of mortality. This group may benefit from more specialised attention in referral centers and should help to identify those patients who might benefit from more aggressive diagnostic and/or therapeutic procedures.
publishDate 2010
dc.date.none.fl_str_mv 2010
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/184878
https://doi.org/10.1186/1471-2334-10-17
url https://hdl.handle.net/11441/184878
https://doi.org/10.1186/1471-2334-10-17
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv BMC Infectious Diseases, 10 (17), 17-23.
REIPI RD06/0008
https://link.springer.com/article/10.1186/1471-2334-10-17
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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