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

Published:March 20, 2019DOI:https://doi.org/10.1016/j.ejim.2019.03.006

      Highlights

      • The clinical presentation of IE is similar to any age of patients.
      • Age ≥ 80 years, high comorbidity and absence of surgery when indicated are predictors of mortality.
      • CCI could help identify those IE patients with less surgical risk, mainly the <65 year group.

      Abstract

      Purpose

      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.

      Methods

      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.

      Results

      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.

      Conclusion

      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.

      Keywords

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      Linked Article

      • Infective endocarditis in patients with cardiac implantable electronic devices: Impact of comorbidities on outcome
        European Journal of Internal MedicineVol. 66
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          We read with interest the paper by Armiñanzasa et al., recently published in the European Journal of Internal Medicine [1]. The authors provided an important analysis of a large, prospectively collected, cohort of patients with possible/definite infective endocarditis enrolled in the Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES) registry maintained by 39 Spanish hospitals from January 2008 to April 2015. According to this analysis an age ≥ 80 years, a Charlson Comorbidity Index score ≥ 3, and absence of surgical reparation, were independent predictors of mortality.
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