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

Adult Age Factors Aged Aged, 80 and over Area Under Curve Comorbidity Databases, Factual Endocarditis / etiology Female Heart Failure / mortality Hospital Mortality Humans Male Middle Aged Proportional Hazards Models Prospective Studies ROC Curve Risk Factors Spain / epidemiology Staphylococcal Infections / mortality

Age Charlson index Comorbidity Endocarditis Surgery

Journal

European journal of internal medicine

ISSN: 1879-0828

Titre abrégé: Eur J Intern Med

Pays: Netherlands

ID NLM: 9003220

Informations de publication

Date de publication:
Jun 2019

Historique:

received: 29 12 2018

revised: 22 02 2019

accepted: 05 03 2019

pubmed: 25 3 2019

medline: 24 7 2020

entrez: 25 3 2019

Statut: ppublish

Résumé

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. 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. 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. 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.

Identifiants

DOI: 10.1016/j.ejim.2019.03.006 PMID: 30904433

pubmed: 30904433

pii: S0953-6205(19)30082-2

doi: 10.1016/j.ejim.2019.03.006

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

63-71

Commentaires et corrections

Type : CommentIn