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Prediction of Symptomatic Embolism in Infective Endocarditis

2013; Elsevier BV; Volume: 62; Issue: 15 Linguagem: Inglês

10.1016/j.jacc.2013.07.029

1558-3597

Sandrine Hubert, Franck Thuny, Noémie Resseguier, Roch Giorgi, Christophe Tribouilloy, Yvan Le Dolley, Jean‐Paul Casalta, Alberto Ribéri, Florent Chevalier, Dan Ruşinaru, Dorothée Malaquin, Jean Paul Rémadi, Ammar Ben Ammar, Jean-François Aviérinos, Frédéric Collart, Didier Raoult, Gilbert Habib,

Antimicrobial Resistance in Staphylococcus

The aim of this study was to develop and validate a simple calculator to quantify the embolic risk (ER) at admission of patients with infective endocarditis. Early valve surgery reduces the incidence of embolism in high-risk patients with endocarditis, but the quantification of ER remains challenging. From 1,022 consecutive patients presenting with definite diagnoses 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 after the initiation of treatment. The prediction model was developed and validated accounting for competing risks. The 6-month incidence of embolism was similar in the development and validation samples (8.5% in the 2 samples). Six variables were associated with ER and were used to create the calculator: age, diabetes, atrial fibrillation, embolism before antibiotics, vegetation length, and Staphylococcus aureus infection. There was an excellent correlation between the predicted and observed ER in both the development and validation samples. The C-statistics for the development and validation samples were 0.72 and 0.65, respectively. Finally, a significantly higher cumulative incidence of embolic events was observed in patients with high predicted ER in both the development (p < 0.0001) and validation (p < 0.05) samples. The risk for embolism during infective endocarditis can be quantified at admission using a simple and accurate calculator. It might be useful for facilitating therapeutic decisions.