Role of age and comorbidities in mortality of patients with infective endocarditis

被引：43

作者：

Arminanzas, Carlos ^{[1
]}

Farinas-Alvarez, Concepcion ^{[2
,30
]}

Zarauza, Jesus ^{[3
,30
]}

Munoz, Patricia ^{[4
,5
,28
]}

Gonzalez Ramallo, Victor ^{[6
,28
]}

Martinez Selles, Manuel ^{[7
,8
]}

Miro Meda, Jose Ma ^{[9
]}

Manuel Pericas, Juan ^{[52
]}

Angel Goenaga, Miguel ^{[10
,20
]}

Ojeda Burgos, Guillermo ^{[11
]}

Rodriguez Alvarez, Regino ^{[12
,13
]}

Castelo Corral, Laura ^{[14
]}

Galvez-Acebal, Juan ^{[15
]}

Martinez Marcos, Francisco Javier ^{[16
]}

Carmen Farinas, Maria ^{[30
,51
]}

Fernandez Sanchez, Fernando ^{[17
]}

Noureddine, Mariam ^{[17
]}

Rosas, Gabriel ^{[17
]}

de la Torre Lima, Javier ^{[17
]}

Aramendi, Jose ^{[18
]}

Bereciartua, Elena ^{[18
]}

Jose Blanco, Maria ^{[18
]}

Blanco, Roberto ^{[18
]}

Victoria Boado, Maria ^{[18
]}

Campana Lazaro, Marta ^{[18
]}

Crespo, Alejandro ^{[18
]}

Goikoetxea, Josune ^{[18
]}

Ramon Iruretagoyena, Jose ^{[18
]}

Irurzun Zuazabal, Josu ^{[18
]}

Lopez-Soria, Leire ^{[18
]}

Montejo, Miguel ^{[18
]}

Nieto, Javier ^{[18
]}

Rodrigo, David ^{[18
]}

Rodriguez, David ^{[18
]}

Rodriguez, Regino ^{[18
]}

Vitoria, Yolanda ^{[18
]}

Voces, Roberto ^{[18
]}

Garcia Lopez, Ma Victoria ^{[19
]}

Ivanova Georgieva, Radka ^{[19
]}

Ojeda, Guillermo ^{[19
]}

Rodriguez Bailon, Isabel ^{[19
]}

Ruiz Morales, Josefa ^{[19
]}

Maria Cuende, Ana ^{[20
]}

Echeverria, Tomas ^{[20
]}

Fuerte, Ana ^{[20
]}

Gaminde, Eduardo ^{[20
]}

Idigoras, Pedro ^{[20
]}

Antonio Iribarren, Jose ^{[20
]}

Izaguirre Yarza, Alberto ^{[20
]}

Kortajarena Urkola, Xabier ^{[20
]}

机构：

[1] Univ Cantabria, Infect Dis Unit, IDIVAL, Hosp Univ Marques Valdecilla, Santander, Spain

[2] IDIVAL, Hosp Univ Marques Valdecilla, Div Hlth Care Qual, Santander, Spain

[3] Hosp Univ Marques Valdecilla, Santander, Spain

[4] Hosp Gen Univ Gregorio Maranon, Serv Microbiol Clin & Enfermedades Infecciosa, Madrid, Spain

[5] Univ Complutense Madrid, Fac Med, Inst Invest Sanitaria Gregorio Maranon, CIBER Enfermedades Resp CIBERES CB06 06 0058, Madrid, Spain

[6] Hosp Gen Univ Gregorio Maranon, Hospitalizac Domicilio, Serv Med Interna, Madrid, Spain

[7] Hosp Gen Univ Gregorio Maranon, Serv Cardiol, Madrid, Spain

[8] Univ Complutense, Univ Europea, Madrid, Spain

[9] Univ Barcelona, Serv Enfermedades Infecciosas, Hosp Clin IDIBAPS, Barcelona, Spain

[10] Hosp Univ Donosti, Serv Enfermedades Infecciosas, San Sebastian, Spain

[11] Hosp Univ Virgen Victoria, Serv Med Interna, Malaga, Spain

[12] Hosp Univ Cruces, Unidad Enfermedades Infecciosas, Bilbao, Spain

[13] Univ Basque Country, Pais Vasco, Spain

[14] Complejo Hosp A Coruna, Serv Enfermedades Infecciosas, La Coruna, Spain

[15] Univ Seville, JUnidad Clin Enfermedades Infecciosas & Microbiol, Hosp Univ Virgen Macarena, Inst Biomed Sevilla,IBIS, Seville, Spain

[16] Hosp Juan Ramon Jimenez, Serv Enfermedades Infecciosas, Huelva, Spain

[17] Hosp Costa Sol, Marbella, Spain

[18] Hosp Univ Cruces, Bilbao, Spain

[19] Hosp Univ Virgen Victoria, Malaga, Spain

[20] Hosp Univ Donostia Policlin Gipuzkoa, San Sebastian, Spain

[21] Hosp Gen Univ Alicante, Alicante, Spain

[22] Complejo Hosp Univ A Coruna, La Coruna, Spain

[23] Univ Huelva, Complejo Hosp, Huelva, Spain

[24] Hosp Univ Canarias, Canarias, Spain

[25] Hosp Reg Univ Malaga, Malaga, Spain

[26] Hosp Univ Cent Asturias, Oviedo, Spain

[27] Univ Barcelona, Hosp Clin IDIBAPS, Barcelona, Spain

[28] Hosp Gen Univ Gregorio Maranon, Madrid, Spain

[29] Hosp Univ La Paz, Madrid, Spain

[30] Univ Marques Valdecilla, Santander, Spain

[31] Hosp Univ Puerta Hierro, Madrid, Spain

[32] Hosp Univ Ramon y Cajal, Madrid, Spain

[33] Hosp Univ Virgen Nieves, Granada, Spain

[34] Hosp Univ Virgen Macarena, Seville, Spain

[35] Hosp Univ Virgen Rocio, Seville, Spain

[36] Hosp San Pedro, Logrono, Spain

[37] Hosp Santa Creu i St Pau, Barcelona, Spain

[38] Univ Santiago Compostela, Complejo Hosp, La Coruna, Spain

[39] Hosp Santiago Apostol, Vitoria, Spain

[40] Hosp SAS Linea Concepcion, Cadiz, Spain

[41] Hosp Clin Univ Virgen Arrixaca Murcia, El Palmar, Spain

[42] Hosp Txagorritxu, Vitoria, Spain

[43] Hosp Virgen Salud, Toledo, Spain

[44] Hosp Rafael Mendez, Murcia, Spain

[45] Hosp Univ San Cecilio Granada, Granada, Spain

[46] Hosp Son Llatzer Palma Mallorca, Illes Balears, Spain

[47] Hosp Univ Miguel Servet Zaragoza, Zaragoza, Spain

[48] Hosp Gen Univ Santa Lucia Cartagena, Murcia, Spain

[49] Hosp Univ Son Espases Palma Mallorca, Palma De Mallorca, Spain

[50] Univ Albacete Albacete, Complejo Hosp, Albacete, Spain

来源：

EUROPEAN JOURNAL OF INTERNAL MEDICINE | 2019年 / 64卷

关键词：

Endocarditis; Age; Charlson index; Comorbidity; Surgery; PROSTHETIC VALVE ENDOCARDITIS; ELDERLY-PATIENTS; CO-MORBIDITY; MANAGEMENT; DIAGNOSIS; EPIDEMIOLOGY; CRITERIA; SURGERY; INDEX; OLD;

D O I：

10.1016/j.ejim.2019.03.006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:< 65 years, 65 to 80 years, and >= 80 years. The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years; 1291 65-80 years; 502 >= 80 years) were enrolled. Fever and heart failure were the most common presentations of IE, with no differences among age groups. Patients >= 80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, >= 80 years). In-hospital mortality was lower in the< 65-year group (20.3%,< 65 years; 30.1%, 65-79 years; 34.7%, >= 80 years; p < 0.001) as well as 1-year mortality (3.2%,< 65 years; 5.5%, 65-80 years; 7.6%, >= 80 years; p= 0.003). Independent predictors of mortality were age >= 80 years (hazard ratio [HR]: 2.78; 95% confidence interval [CI]: 2.32-3.34), CCI >= 3 (HR: 1.62; 95% CI: 1.39-1.88), and non-performed surgery (HR: 1.64; 95% CI: 11.16-1.58). When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged< 65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age >= 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE. CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the< 65-year group.

引用

页码：63 / 71

页数：9

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