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Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study.
- Source :
-
Circulation. Cardiovascular imaging [Circ Cardiovasc Imaging] 2015 Jul; Vol. 8 (7), pp. e003397. - Publication Year :
- 2015
-
Abstract
- Background: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown.<br />Methods and Results: Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S aureus IE. One-year survival rates were significantly lower for patients with S aureus IE overall (57% S aureus IE versus 80% non-S aureus IE; P<0.001) and in the propensity-matched cohort (59% S aureus IE versus 68% non-S aureus IE; P<0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52-5.40; P<0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26-3.78; P=0.004) were the only independent predictors of 1-year mortality.<br />Conclusions: S aureus is an independent predictor of 1-year mortality in subjects with LNVIE. In S aureus LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality.<br /> (© 2015 American Heart Association, Inc.)
- Subjects :
- Abscess microbiology
Abscess physiopathology
Adult
Aged
Case-Control Studies
Cooperative Behavior
Endocarditis, Bacterial microbiology
Endocarditis, Bacterial physiopathology
Female
Humans
International Cooperation
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Registries
Risk Assessment
Risk Factors
Staphylococcal Infections microbiology
Staphylococcal Infections physiopathology
Stroke Volume
Ventricular Function, Left
Abscess diagnostic imaging
Abscess mortality
Echocardiography, Transesophageal
Endocarditis, Bacterial diagnostic imaging
Endocarditis, Bacterial mortality
Hospital Mortality
Staphylococcal Infections diagnostic imaging
Staphylococcal Infections mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1942-0080
- Volume :
- 8
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 26162783
- Full Text :
- https://doi.org/10.1161/CIRCIMAGING.114.003397