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Complicated Left-Sided Native Valve Endocarditis in Adults: Risk Classification for Mortality.
- Source :
-
JAMA: Journal of the American Medical Association . 4/16/2003, Vol. 289 Issue 15, p1933. 8p. - Publication Year :
- 2003
-
Abstract
- Context: Complicated left-sided native valve endocarditis causes significant morbidity and mortality in adults. Lack of valid data regarding estimation of prognosis makes management of this condition difficult. Objective: To derive and externally validate a prognostic classification system for adults with complicated left-sided native valve endocarditis. Design, Setting, and Patients: Retrospective observational cohort study conducted from January 1990 to January 2000 at 7 Connecticut hospitals among 513 patients older than 16 years who experienced complicated left-sided native valve endocarditis and who were divided into derivation (n = 259) and validation (n = 254) cohorts. Main Outcome Measure: All-cause mortality at 6 months after baseline. Results: In the derivation and validation cohorts, the 6-month mortality rates were 25% and 26%, respectively. Five baseline features were independently associated with 6-month mortality (comorbidity [P = .03], abnormal mental status [P = .02], moderate to severe congestive heart failure [P = .01], bacterial etiology other than viridans streptococci [P<.001 except Staphylococcus aureus, P = .004], and medical therapy without valve surgery [P = .002]) and were used to create a prognostic classification system. In the derivation cohort, patients were classified into 4 groups with increasing risk for 6-month mortality: 5%, 15%, 31%, and 59% (P<.001). In the validation cohort, a similar risk among the 4 groups was observed: 7%, 19%, 32%, and 69% (P<.001). Conclusions: Adults with complicated left-sided native valve endocarditis can be accurately risk stratified using baseline features into 4 groups of prognostic severity. This prognostic classification system might be useful for facilitating management decisions. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ENDOCARDITIS
*MORTALITY
*HEART failure
*STAPHYLOCOCCUS aureus
*MEDICAL research
Subjects
Details
- Language :
- English
- ISSN :
- 00987484
- Volume :
- 289
- Issue :
- 15
- Database :
- Academic Search Index
- Journal :
- JAMA: Journal of the American Medical Association
- Publication Type :
- Academic Journal
- Accession number :
- 9527127
- Full Text :
- https://doi.org/10.1001/jama.289.15.1933