- 作者：S ; rine Hubert ; Franck Thuny ; Noemie Resseguier ; Roch Giorgi ; Christophe Tribouilloy ; Yvan Le Dolley ; Jean-Paul Casalta ; Alberto Riberi ; Florent Chevalier ; Dan Rusinaru ; Doroth¨¦e Malaquin ; Jean Paul Remadi ; Ammar Ben Ammar ; Jean Francois Avierinos ; Frederic Collart ; Didier Raoult ; Gilbert Habib
- 关键词：embolism ; endocarditis ; prognosis
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：8 October, 2013
- 年：2013
- 卷：62
- 期：15
- 页码：1384-1392
- 全文大小：812 K
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.