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

Park, Lawrence P, Chu, Vivian H, Peterson, Gail, Skoutelis, Athanasios, Lejko-Zupa, Tatjana, Bouza, Emilio, Tattevin, Pierre, Habib, Gilbert, Tan, Ren, Gonzalez, Javier, Altclas, Javier, Edathodu, Jameela, Fortes, Claudio Q, Siciliano, Rinaldo Focaccia, Pachirat, Orathai, Kanj, Souha, Wang, Andrew, International Collaboration on Endocarditis (ICE) Investigators and Athan, Eugene 2016, Validated risk score for predicting 6-month mortality in infective endocarditis, Journal of the American Heart Association, vol. 5, no. 4, pp. 1-13, doi: 10.1161/JAHA.115.003016.

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Title Validated risk score for predicting 6-month mortality in infective endocarditis
Author(s) Park, Lawrence P
Chu, Vivian H
Peterson, Gail
Skoutelis, Athanasios
Lejko-Zupa, Tatjana
Bouza, Emilio
Tattevin, Pierre
Habib, Gilbert
Tan, Ren
Gonzalez, Javier
Altclas, Javier
Edathodu, Jameela
Fortes, Claudio Q
Siciliano, Rinaldo Focaccia
Pachirat, Orathai
Kanj, Souha
Wang, Andrew
International Collaboration on Endocarditis (ICE) Investigators
Athan, EugeneORCID iD for Athan, Eugene orcid.org/0000-0001-9838-6471
Journal name Journal of the American Heart Association
Volume number 5
Issue number 4
Article ID e003016
Start page 1
End page 13
Total pages 13
Publisher John Wiley & Sons
Place of publication Chichester, Eng.
Publication date 2016-04-22
ISSN 2047-9980
2047-9980
Keyword(s) infection
mortality
prognosis
surgery
valves
endocarditis
Kaplan-Meier estimate
propensity score
registries
risk factors
sensitivity and specificity
Summary 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.
Language eng
DOI 10.1161/JAHA.115.003016
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2016, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution non-commercial licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30110112

Document type: Journal Article
Collections: School of Medicine
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.