Validated risk score for predicting 6-month mortality in infective endocarditis

Lawrence P. Park; Vivian H. Chu; Gail Peterson; Athanasios Skoutelis; Tatjana Lejko-Zupa; Emilio Bouza; Pierre Tattevin; Gilbert Habib; Ren Tan; Javier Gonzalez; Javier Altclas; Jameela Edathodu; Claudio Querido Fortes; Rinaldo Focaccia Siciliano; Orathai Pachirat; Souha Kanj; Andrew Wang; for the International Collaboration on Endocarditis (ICE) Investigators; Marcelo Luiz Campos Vieira; Didier Raoult; Christoph Naber; Jorge  Roda; Marta Rodríguez-Créixems; Jorge Solis; Pimchitra Pachirat; Burabha Pussadhamma; Vichai Senthong; Stuart A. Dickerman

doi:10.1161/JAHA.115.003016

Validated risk score for predicting 6-month mortality in infective endocarditis

Lawrence P. Park, Vivian H. Chu, Gail Peterson, Athanasios Skoutelis, Tatjana Lejko-Zupa, Emilio Bouza, Pierre Tattevin, Gilbert Habib, Ren Tan, Javier Gonzalez, Javier Altclas, Jameela Edathodu, Claudio Querido Fortes, Rinaldo Focaccia Siciliano, Orathai Pachirat, Souha Kanj, Andrew Wang, for the International Collaboration on Endocarditis (ICE) Investigators, Marcelo Luiz Campos Vieira, Didier RaoultChristoph Naber, Jorge Roda, Marta Rodríguez-Créixems, Jorge Solis, Pimchitra Pachirat, Burabha Pussadhamma, Vichai Senthong, Stuart A. Dickerman

Research output: Contribution to journal › Article › peer-review

116 Citations (Scopus)

81 Downloads (Pure)

Abstract

Background-Host 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 Results-Using 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. Conclusions-Six-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.

Original language	English
Article number	e003016
Number of pages	13
Journal	Journal of the American Heart Association
Volume	5
Issue number	4
DOIs	https://doi.org/10.1161/JAHA.115.003016
Publication status	Published - 1 Apr 2016
Externally published	Yes

Keywords

Infection
Mortality
Prognosis
Surgery
Valves

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1161/JAHA.115.003016Licence: CC BY

Lawrence_Validated_P2016Final published version, 453 KBLicence: CC BY

Cite this

Park, L. P., Chu, V. H., Peterson, G., Skoutelis, A., Lejko-Zupa, T., Bouza, E., Tattevin, P., Habib, G., Tan, R., Gonzalez, J., Altclas, J., Edathodu, J., Fortes, C. Q., Siciliano, R. F., Pachirat, O., Kanj, S., Wang, A., for the International Collaboration on Endocarditis (ICE) Investigators, Vieira, M. L. C., ... Dickerman, S. A. (2016). Validated risk score for predicting 6-month mortality in infective endocarditis. Journal of the American Heart Association, 5(4), Article e003016. https://doi.org/10.1161/JAHA.115.003016

@article{faf751ca618840fab05875c6037b44bd,

title = "Validated risk score for predicting 6-month mortality in infective endocarditis",

abstract = "Background-Host 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 Results-Using 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. Conclusions-Six-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.",

keywords = "Infection, Mortality, Prognosis, Surgery, Valves",

author = "Park, {Lawrence P.} and Chu, {Vivian H.} and Gail Peterson and Athanasios Skoutelis and Tatjana Lejko-Zupa and Emilio Bouza and Pierre Tattevin and Gilbert Habib and Ren Tan and Javier Gonzalez and Javier Altclas and Jameela Edathodu and Fortes, {Claudio Querido} and Siciliano, {Rinaldo Focaccia} and Orathai Pachirat and Souha Kanj and Andrew Wang and {for the International Collaboration on Endocarditis (ICE) Investigators} and Liliana Clara and Marisa LSanchez and Jos{\'e} Casab{\'e} and Claudia Cortes and Francisco Nacinovich and Oses, {Pablo Fernandez} and Ricardo Ronderos and Adriana Sucari and Jorge Thierer and Silvia Kogan and Denis Spelman and Eugene Athan and Owen Harris and Karina Kennedy and David Gordon and Lito Papanicolas and Tony Korman and Despina Kotsanas and Robyn Dever and Phillip Jones and Pam Konecny and Richard Lawrence and David Rees and Suzanne Ryan and Feneley, {Michael P.} and John Harkness and Jeffrey Post and Porl Reinbott and Rainer Gattringer and Franz Wiesbauer and Andrade, {Adriana Ribas} and {de Brito}, {Ana Cl{\'a}udia Passos} and Guimar{\~a}es, {Armenio Costa} and Max Grinberg and Mansur, {Alfredo Jos{\'e}} and Vieira, {Marcelo Luiz Campos} and Tranchesi, {Regina Aparecida de Medeiros} and Paiva, {Marcelo Goulart} and Ramos, {Auristela de Oliveira} and Clara Weksler and Giovanna Ferraiuoli and Wilma Golebiovski and Cristiane Lamas and James, {A. Karlowsky} and Yoav Keynan and Morris, {Andrew M.} and Ethan Rubinstein and Jones, {Sandra Braun} and Patricia Garcia and M. Cereceda and Alberto Fica and Mella, {Rodrigo Montagna} and Ricardo Fernandez and Liliana Franco and Jaramillo, {Astrid Natalia} and Bruno Barsic and Suzana Bukovski and Vladimir Krajinovic and Ana Pangercic and Igor Rudez and Josip Vincelj and Tomas Freiberger and Jiri Pol and Barbora Zaloudikova and Zainab Ashour and Kholy, {Amani El} and Marwa Mishaal and Dina Osama and Hussien Rizk and Neijla Aissa and Corentine Alauzet and Francois Alla and Catherine Campagnac and Thanh Doco-Lecompte and Christine Selton-Suty and Casalta, {Jean Paul} and Fournier, {Pierre Edouard} and Didier Raoult and Franck Thuny and Francois Delahaye and Armelle Delahaye and Francois Vandenesch and Erwan Donal and Donnio, {Pierre Yves} and Erwan Flecher and Christian Michelet and Matthieu Revest and Pierre Tattevin and Florent Chevalier and Antoine Jeu and Remadi, {Jean Paul} and Dan Rusinaru and Christophe Tribouilloy and Yvette Bernard and Catherine Chirouze and Bruno Hoen and Joel Leroy and Patrick Plesiat and Christoph Naber and Carl Neuerburg and Bahram Mazaheri and Sophia Athanasia and Ioannis Deliolanis and Helen Giamarellou and Tsaganos Thomas and Efthymia Giannitsioti and Elena Mylona and Olga Paniara and Konstantinos Papanicolaou and John Pyros and Athanasios Skoutelis and Gautam Sharma and Johnson Francis and Lathi Nair and Vinod Thomas and Krishnan Venugopal and Hannan, {Margaret M.} and Hurley, {John P.} and Amos Cahan and Dan Gilon and Sarah Israel and Maya Korem and Jacob Strahilevitz and Ethan Rubinstein and Jacob Strahilevitz and Emanuele Durante-Mangoni and Irene Mattucci and Daniela Pinto and Federica Agrusta and Alessandra Senese and Enrico Ragone and Riccardo Utili and Enrico Cecchi and Rosa, {Francesco De} and Davide Forno and Massimo Imazio and Rita Trinchero and Paolo Grossi and Mariangela Lattanzio and Antonio Toniolo and Antonio Goglio and Annibale Raglio and Veronica Ravasio and Marco Rizzi and Fredy Suter and Giampiero Carosi and Silvia Magri and Liana Signorini and Kanafani, {Zeina A.} and Ahmad Sharif-Yakan and Imran Abidin and Tamin, {Syahidah Syed} and Martinez, {Eduardo Rivera} and Nieto, {Gabriel Israel Soto} and Meer, {Jan T.M.van der} and Stephen Chambers and David Holland and Arthur Morris and Nigel Raymond and Kerry Read and Murdoch, {David R.} and Stefan Dragulescu and Adina Ionac and Cristian Mornos and Butkevich, {O. M.} and Natalia Chipigina and Ozerecky Kirill and Kulichenko Vadim and Tatiana Vinogradova and Magid Halim and Liew, {Yee Yun} and Tan, {Ru San} and Tatjana Lejko-Zupanc and Mateja Logar and Manica Mueller-Premru and Patrick Commerford and Anita Commerford and Eduan Deetlefs and Cass Hansa and Mpiko Ntsekhe and Manuel Almela and Yolanda Armero and Manuel Azqueta and Ximena Casta{\~n}eda and Carlos Cervera and Carlos Falces and Cristina Garcia-de-la-Maria and Guillermina Fita and Gatell, {Jose M.} and Magda Heras and Jaime Llopis and Francesc Marco and Mestres, {Carlos A.} and Miro, {Jose M.} and Asuncion Moreno and Salvador Ninot and Carlos Pare and Pericas, {Juan M.} and Jose Ramirez and Irene Rovira and Marta Sitges and Ignasi Anguera and Bernat Font and Guma, {Joan Raimon} and Fern{\'a}ndez, {Miguel Angel Garcia} and Victor Gonzalez-Ramallo and Mercedes Marin and Patricia Mu{\~n}oz and Miguel Pedromingo and Jorge Roda and Marta Rodr{\'i}guez-Cr{\'e}ixems and Jorge Solis and Benito Almirante and Nuria Fernandez-Hidalgo and Pilar Tornos and Alarcon, {Aristides de} and Ricardo Parra and Eric Alestig and Magnus Johansson and Lars Olaison and Ulrika Snygg-Martin and Pimchitra Pachirat and Burabha Pussadhamma and Vichai Senthong and Anna Casey and Tom Elliott and Peter Lambert and Richard Watkin and Christina Eyton and Klein, {John L.} and Suzanne Bradley and Carol Kauffman and Roger Bedimo and Stamatios Lerakis and Robert Cantey and Lisa Steed and Dannah Wray and Dickerman, {Stuart A.} and Hector Bonilla and Joseph DiPersio and Salstrom, {Sara Jane} and John Baddley and Mukesh Patel and Jonathan Riddle",

year = "2016",

month = apr,

day = "1",

doi = "10.1161/JAHA.115.003016",

language = "English",

volume = "5",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "AHA Journals",

number = "4",

}

Park, LP, Chu, VH, Peterson, G, Skoutelis, A, Lejko-Zupa, T, Bouza, E, Tattevin, P, Habib, G, Tan, R, Gonzalez, J, Altclas, J, Edathodu, J, Fortes, CQ, Siciliano, RF, Pachirat, O, Kanj, S, Wang, A, for the International Collaboration on Endocarditis (ICE) Investigators, Vieira, MLC, Raoult, D, Naber, C, Roda, J, Rodríguez-Créixems, M, Solis, J, Pachirat, P, Pussadhamma, B, Senthong, V & Dickerman, SA 2016, 'Validated risk score for predicting 6-month mortality in infective endocarditis', Journal of the American Heart Association, vol. 5, no. 4, e003016. https://doi.org/10.1161/JAHA.115.003016

TY - JOUR

T1 - Validated risk score for predicting 6-month mortality in infective endocarditis

AU - Park, Lawrence P.

AU - Chu, Vivian H.

AU - Peterson, Gail

AU - Skoutelis, Athanasios

AU - Lejko-Zupa, Tatjana

AU - Bouza, Emilio

AU - Tattevin, Pierre

AU - Habib, Gilbert

AU - Tan, Ren

AU - Gonzalez, Javier

AU - Altclas, Javier

AU - Edathodu, Jameela

AU - Fortes, Claudio Querido

AU - Siciliano, Rinaldo Focaccia

AU - Pachirat, Orathai

AU - Kanj, Souha

AU - Wang, Andrew

AU - for the International Collaboration on Endocarditis (ICE) Investigators

AU - Clara, Liliana

AU - LSanchez, Marisa

AU - Casabé, José

AU - Cortes, Claudia

AU - Nacinovich, Francisco

AU - Oses, Pablo Fernandez

AU - Ronderos, Ricardo

AU - Sucari, Adriana

AU - Thierer, Jorge

AU - Kogan, Silvia

AU - Spelman, Denis

AU - Athan, Eugene

AU - Harris, Owen

AU - Kennedy, Karina

AU - Gordon, David

AU - Papanicolas, Lito

AU - Korman, Tony

AU - Kotsanas, Despina

AU - Dever, Robyn

AU - Jones, Phillip

AU - Konecny, Pam

AU - Lawrence, Richard

AU - Rees, David

AU - Ryan, Suzanne

AU - Feneley, Michael P.

AU - Harkness, John

AU - Post, Jeffrey

AU - Reinbott, Porl

AU - Gattringer, Rainer

AU - Wiesbauer, Franz

AU - Andrade, Adriana Ribas

AU - de Brito, Ana Cláudia Passos

AU - Guimarães, Armenio Costa

AU - Grinberg, Max

AU - Mansur, Alfredo José

AU - Vieira, Marcelo Luiz Campos

AU - Tranchesi, Regina Aparecida de Medeiros

AU - Paiva, Marcelo Goulart

AU - Ramos, Auristela de Oliveira

AU - Weksler, Clara

AU - Ferraiuoli, Giovanna

AU - Golebiovski, Wilma

AU - Lamas, Cristiane

AU - James, A. Karlowsky

AU - Keynan, Yoav

AU - Morris, Andrew M.

AU - Rubinstein, Ethan

AU - Jones, Sandra Braun

AU - Garcia, Patricia

AU - Cereceda, M.

AU - Fica, Alberto

AU - Mella, Rodrigo Montagna

AU - Fernandez, Ricardo

AU - Franco, Liliana

AU - Jaramillo, Astrid Natalia

AU - Barsic, Bruno

AU - Bukovski, Suzana

AU - Krajinovic, Vladimir

AU - Pangercic, Ana

AU - Rudez, Igor

AU - Vincelj, Josip

AU - Freiberger, Tomas

AU - Pol, Jiri

AU - Zaloudikova, Barbora

AU - Ashour, Zainab

AU - Kholy, Amani El

AU - Mishaal, Marwa

AU - Osama, Dina

AU - Rizk, Hussien

AU - Aissa, Neijla

AU - Alauzet, Corentine

AU - Alla, Francois

AU - Campagnac, Catherine

AU - Doco-Lecompte, Thanh

AU - Selton-Suty, Christine

AU - Casalta, Jean Paul

AU - Fournier, Pierre Edouard

AU - Raoult, Didier

AU - Thuny, Franck

AU - Delahaye, Francois

AU - Delahaye, Armelle

AU - Vandenesch, Francois

AU - Donal, Erwan

AU - Donnio, Pierre Yves

AU - Flecher, Erwan

AU - Michelet, Christian

AU - Revest, Matthieu

AU - Tattevin, Pierre

AU - Chevalier, Florent

AU - Jeu, Antoine

AU - Remadi, Jean Paul

AU - Rusinaru, Dan

AU - Tribouilloy, Christophe

AU - Bernard, Yvette

AU - Chirouze, Catherine

AU - Hoen, Bruno

AU - Leroy, Joel

AU - Plesiat, Patrick

AU - Naber, Christoph

AU - Neuerburg, Carl

AU - Mazaheri, Bahram

AU - Athanasia, Sophia

AU - Deliolanis, Ioannis

AU - Giamarellou, Helen

AU - Thomas, Tsaganos

AU - Giannitsioti, Efthymia

AU - Mylona, Elena

AU - Paniara, Olga

AU - Papanicolaou, Konstantinos

AU - Pyros, John

AU - Skoutelis, Athanasios

AU - Sharma, Gautam

AU - Francis, Johnson

AU - Nair, Lathi

AU - Thomas, Vinod

AU - Venugopal, Krishnan

AU - Hannan, Margaret M.

AU - Hurley, John P.

AU - Cahan, Amos

AU - Gilon, Dan

AU - Israel, Sarah

AU - Korem, Maya

AU - Strahilevitz, Jacob

AU - Rubinstein, Ethan

AU - Strahilevitz, Jacob

AU - Durante-Mangoni, Emanuele

AU - Mattucci, Irene

AU - Pinto, Daniela

AU - Agrusta, Federica

AU - Senese, Alessandra

AU - Ragone, Enrico

AU - Utili, Riccardo

AU - Cecchi, Enrico

AU - Rosa, Francesco De

AU - Forno, Davide

AU - Imazio, Massimo

AU - Trinchero, Rita

AU - Grossi, Paolo

AU - Lattanzio, Mariangela

AU - Toniolo, Antonio

AU - Goglio, Antonio

AU - Raglio, Annibale

AU - Ravasio, Veronica

AU - Rizzi, Marco

AU - Suter, Fredy

AU - Carosi, Giampiero

AU - Magri, Silvia

AU - Signorini, Liana

AU - Kanafani, Zeina A.

AU - Sharif-Yakan, Ahmad

AU - Abidin, Imran

AU - Tamin, Syahidah Syed

AU - Martinez, Eduardo Rivera

AU - Nieto, Gabriel Israel Soto

AU - Meer, Jan T.M.van der

AU - Chambers, Stephen

AU - Holland, David

AU - Morris, Arthur

AU - Raymond, Nigel

AU - Read, Kerry

AU - Murdoch, David R.

AU - Dragulescu, Stefan

AU - Ionac, Adina

AU - Mornos, Cristian

AU - Butkevich, O. M.

AU - Chipigina, Natalia

AU - Kirill, Ozerecky

AU - Vadim, Kulichenko

AU - Vinogradova, Tatiana

AU - Halim, Magid

AU - Liew, Yee Yun

AU - Tan, Ru San

AU - Lejko-Zupanc, Tatjana

AU - Logar, Mateja

AU - Mueller-Premru, Manica

AU - Commerford, Patrick

AU - Commerford, Anita

AU - Deetlefs, Eduan

AU - Hansa, Cass

AU - Ntsekhe, Mpiko

AU - Almela, Manuel

AU - Armero, Yolanda

AU - Azqueta, Manuel

AU - Castañeda, Ximena

AU - Cervera, Carlos

AU - Falces, Carlos

AU - Garcia-de-la-Maria, Cristina

AU - Fita, Guillermina

AU - Gatell, Jose M.

AU - Heras, Magda

AU - Llopis, Jaime

AU - Marco, Francesc

AU - Mestres, Carlos A.

AU - Miro, Jose M.

AU - Moreno, Asuncion

AU - Ninot, Salvador

AU - Pare, Carlos

AU - Pericas, Juan M.

AU - Ramirez, Jose

AU - Rovira, Irene

AU - Sitges, Marta

AU - Anguera, Ignasi

AU - Font, Bernat

AU - Guma, Joan Raimon

AU - Fernández, Miguel Angel Garcia

AU - Gonzalez-Ramallo, Victor

AU - Marin, Mercedes

AU - Muñoz, Patricia

AU - Pedromingo, Miguel

AU - Roda, Jorge

AU - Rodríguez-Créixems, Marta

AU - Solis, Jorge

AU - Almirante, Benito

AU - Fernandez-Hidalgo, Nuria

AU - Tornos, Pilar

AU - Alarcon, Aristides de

AU - Parra, Ricardo

AU - Alestig, Eric

AU - Johansson, Magnus

AU - Olaison, Lars

AU - Snygg-Martin, Ulrika

AU - Pachirat, Pimchitra

AU - Pussadhamma, Burabha

AU - Senthong, Vichai

AU - Casey, Anna

AU - Elliott, Tom

AU - Lambert, Peter

AU - Watkin, Richard

AU - Eyton, Christina

AU - Klein, John L.

AU - Bradley, Suzanne

AU - Kauffman, Carol

AU - Bedimo, Roger

AU - Lerakis, Stamatios

AU - Cantey, Robert

AU - Steed, Lisa

AU - Wray, Dannah

AU - Dickerman, Stuart A.

AU - Bonilla, Hector

AU - DiPersio, Joseph

AU - Salstrom, Sara Jane

AU - Baddley, John

AU - Patel, Mukesh

AU - Riddle, Jonathan

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background-Host 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 Results-Using 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. Conclusions-Six-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.

AB - Background-Host 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 Results-Using 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. Conclusions-Six-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.

KW - Infection

KW - Mortality

KW - Prognosis

KW - Surgery

KW - Valves

UR - http://www.scopus.com/inward/record.url?scp=84995655527&partnerID=8YFLogxK

U2 - 10.1161/JAHA.115.003016

DO - 10.1161/JAHA.115.003016

M3 - Article

C2 - 27091179

AN - SCOPUS:84995655527

SN - 2047-9980

VL - 5

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 4

M1 - e003016

ER -

Validated risk score for predicting 6-month mortality in infective endocarditis

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this