Complicated left-sided native valve endocarditis in adults: risk classification for mortality
Rodrigo Hasbun1, Holenarasipur R Vikram, Lydia A Barakat
1Infectious Disease Section, Tulane University School of Medicine, New Orleans, La, USA.
JAMA
|April 17, 2003
Summary
A new prognostic system accurately risk-stratifies adults with complicated left-sided native valve endocarditis into four groups. This tool aids in managing patients with this serious condition, improving outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Prognostics
Background:
- Complicated left-sided native valve endocarditis presents a significant challenge due to high morbidity and mortality.
- A lack of validated prognostic data complicates clinical management strategies.
Purpose of the Study:
- To develop and externally validate a prognostic classification system for adult patients diagnosed with complicated left-sided native valve endocarditis.
Main Methods:
- A retrospective observational cohort study involved 513 adult patients across 7 hospitals from 1990-2000.
- Patients were divided into derivation (n=259) and validation (n=254) cohorts.
- The primary outcome measure was all-cause mortality at 6 months post-baseline.
Main Results:
- Six-month mortality rates were 25% (derivation) and 26% (validation).
- Five independent predictors of mortality were identified: comorbidity, abnormal mental status, congestive heart failure, specific bacterial etiologies, and non-surgical medical management.
- The derived prognostic system classified patients into four risk groups, with 6-month mortality rates ranging from 5% to 59% in the derivation cohort and 7% to 69% in the validation cohort.
Conclusions:
- A validated prognostic classification system using baseline features can accurately stratify adults with complicated left-sided native valve endocarditis.
- This system offers a valuable tool for guiding clinical management decisions and improving patient outcomes.
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