Prognostic implications of a negative echocardiography in patients with infective endocarditis.
Eur J Intern Med
; 52: 40-48, 2018 06.
Article
en En
| MEDLINE
| ID: mdl-29409744
ABSTRACT
BACKGROUND:
Echocardiography plays an important role in infective endocarditis (IE) diagnosis according with the modified Duke criteria. We evaluated the implications of a positive echocardiography in the prognosis of a cohort of patients with IE.METHODS:
Prospective multicentre study in 31 Spanish centres. From January 2008 to September 2016, 3467 patients were included (2765 definite IE, 702 possible IE). The main outcome was in-hospital mortality. Echocardiography diagnosis was based on modified Duke criteria for the diagnosis of IE.RESULTS:
Median age was 69â¯years (interquartile range 57-77â¯years). Comorbidity was high (mean Charlson index 4.7⯱â¯2.8). Transoesophageal echocardiography was performed in 2680 (77.3%). The overall inhospital mortality rate was 26.7%. Univariate analysis showed that, in patients with definite IE, inhospital mortality was similar in patients with positive and negative echocardiography (27.7% vs. 24.6%, respectively, pâ¯=â¯0.121). In possible IE these figures were 27.5% vs. 16.7%, respectively, pâ¯<â¯0.001. Complications (cardiac and extracardiac [embolic, immunological, and septic shock]) were more frequent with positive than with negative echocardiography, regardless of clinical suspicion (definite IE 35.5% vs. 16.8%, respectively, pâ¯<â¯0.001; possible IE 20.8% vs. 7.6%, respectively, pâ¯<â¯0.001). Positive echocardiography was a predictor of inhospital death by logistic regression modelling, after adjusting for confounders, definite IE (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.02-1.76, pâ¯=â¯0.036), possible IE (OR 1.59, 95% CI 1.02-2.45, pâ¯=â¯0.036).CONCLUSIONS:
A positive echocardiography in patients with IE is associated with increased inhospital mortality, in addition to other clinical factors and comorbidities.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Mortalidad Hospitalaria
/
Ecocardiografía Transesofágica
/
Endocarditis
Tipo de estudio:
Clinical_trials
/
Etiology_studies
/
Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
Eur J Intern Med
Asunto de la revista:
MEDICINA INTERNA
Año:
2018
Tipo del documento:
Article
País de afiliación:
España