Prediction of Symptomatic Embolism in Infective Endocarditis: Construction and Validation of a Risk Calculator in a Multicenter Cohort.
J Am Coll Cardiol. 2013 Jul 25;
Authors: Hubert S, Thuny F, Resseguier N, Giorgi R, Tribouilloy C, Le Dolley Y, Casalta JP, Riberi A, Chevalier F, Rusinaru D, Malaquin D, Remadi JP, Ben Ammar A, Avierinos JF, Collart F, Raoult D, Habib G
OBJECTIVES: We sought to develop and validate a simple calculator to quantify the embolic risk (ER) at admission of patients with infective endocarditis.
BACKGROUND: Early valve surgery reduces the incidence of embolism in high-risk patients with endocarditis, however the quantification of the ER remains challenging.
METHODS: From 1,022 consecutive patients presenting with a definite diagnosis of infective endocarditis in a multicenter observational cohort study, 847 were randomized into derivation (n; 565) and validation (n; 282) samples. Clinical, microbiological and echocardiographic data were collected at admission. The primary endpoint was symptomatic embolism that occurred during the 6-month period following the initiation of treatment. The prediction model was developed and validated accounting for competing risks.
RESULTS: The 6-month incidence of embolism was similar in the development and validation samples (8.5% in the two samples). Six variables were associated with the ER and used to create the calculator: age, diabetes, atrial fibrillation, embolism before antibiotics, vegetation length, and Staphylococcus aureus. There was an excellent correlation between the predicted and observed ER both in the development and validation samples. The c statistics for the development and validation samples were 0.72 and 0.65, respectively. Finally, a significant higher cumulative incidence of embolic events was observed in patients with a high predicted ER both in the development (p<0.0001) and validation (p<0.05) samples.
CONCLUSIONS: The risk of embolism during infective endocarditis can be quantified at admission by a simple and accurate calculator. It might be useful for facilitating therapeutic decisions.
PMID: 23906859 [PubMed - as supplied by publisher]