Memoria del Mapa Geológico de España, Escala 1:50.000, 2ª Serie, 1ª Edición, (MAGNA), Hoja Nº 512, Cifuentes

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

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

Clinical and Serological Features in Latin American IgG4-Related Disease Patients Differ According to Sex, Ethnicity, and Clinical Phenotype

Background/Objective Data on IgG4-related disease (IgG4-RD) come almost exclusively from cohorts from Asia, Europe, and North America. We conducted this study to describe the clinical presentation, phenotype distribution, and association with sex, ethnicity, and serological markers in a large cohort of Latin American patients with IgG4-RD. Methods We performed a multicenter medical records review study including 184 Latin American IgG4-RD patients. We assigned patients to clinical phenotypes: group 1 (pancreato-hepato-biliary), group 2 (retroperitoneal/aortic), group 3 (head and neck-limited), group 4 (Mikulicz/systemic), and group 5 (undefined). We focused the analysis on how sex, ethnicity, and clinical phenotype may influence the clinical and serological presentation. Results The mean age was 50.8 ± 15 years. Men and women were equally affected (52.2% vs 48.8%). Fifty-four patients (29.3%) were assigned to group 1, 21 (11.4%) to group 2, 57 (30.9%) to group 3, 32 (17.4%) to group 4, and 20 (10.8%) to group 5. Male sex was associated with biliary tract (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.36-8.26), kidney (OR, 3.4; 95% CI, 1.28-9.25), and retroperitoneal involvement (OR, 5.3; 95% CI, 1.45-20). Amerindian patients presented more frequently with atopy history and gallbladder involvement. Group 3 had a female predominance. Conclusions Latin American patients with IgG4-RD were younger, and men and women were equally affected compared with White and Asian cohorts. They belonged more commonly to group 1 and group 3. Retroperitoneal and aortic involvement was infrequent. Clinical and serological features differed according to sex, ethnicity, and clinical phenotype.Fil: Martín-Nares, Eduardo. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Department of Immunology and Rheumatology; MéxicoFil: Baenas, Diego Federico. Hospital Privado Universitario de Córdoba. Servicio de Reumatología; ArgentinaFil: Cuellar Gutiérrez, María Carolina. Hospital Del Salvador. Departamento de Medicina Interna. Servicio de Reumatología; ChileFil: Hernández-Molina, Gabriela. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Department of Immunology and Rheumatology; MéxicoFil: Ortiz, Alberto Christian. Hospital José María Cullen. Sección de Reumatología; ArgentinaFil: Neira, Oscar. Universidad de Chile. Hospital Del Salvador. Sección Reumatología; ChileFil: Neira, Oscar. Clínica Alemana de Santiago-Universidad Del Desarrollo. Unidad Reumatología; ChileFil: Gutiérrez, Miguel A. Universidad de Valparaíso. Hospital Naval Almirante Nef. Departamento de Reumatologia; ChileFil: Calvo, Romina. Hospital José María Cullen. Sección de Reumatología; ArgentinaFil: Saad, Emanuel José. Hospital Privado Universitario de Córdoba. Departamento de Clínica Médica; ArgentinaFil: Elgueta Pinochet, Sergio. Hospital Clínico de la Universidad de Chile. Sección Reumatología. Departamento de Medicina; ChileFil: Gallo, Jesica. Hospital Central de Reconquista. Sección de Reumatología; ArgentinaFil: Herrera Moya, Alejandra. Pontificia Universidad Católica de Chile. Departamento de Inmunología Clínica y Reumatología; ChileFil: Mansilla Aravena, Bellanides Agustina. Hospital Clínico Magallanes; ArgentinaFil: Crespo Espíndola, María Elena. Hospital Señor Del Milagro; ArgentinaFil: Cairoli, Ernesto. Hospital Evangélico. Unidad de Enfermedades Autoinmunes; BrasilFil: Cairoli, Ernesto. Centro Asistencial Del Sindicato Médico Del Uruguay. Unidad de Enfermedades Autoinmunes; UruguayFil: Cairoli, Ernesto. Institut Pasteur. Laboratorio de Inmunorregulación e Inflamación; UruguayFil: Bertoli, Ana María. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Servicio de Reumatología; ArgentinaFil: Córdoba, Mercedes. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Servicio de Reumatología; ArgentinaFil: Wurmann Kiblisky, Pamela. Hospital Clínico Universidad de Chile.Fil: Basualdo Arancibia, Washington Javier. Departamento de Medicina. Sección Reumatología; ChileFil: Badilla Piñeiro, María Natalia. Hospital Del Salvador, Universidad de Chile. Sección Reumatología; ChileFil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas. Hospital Córdoba; ArgentinaFil: Berbotto, Guillermo Ariel. Sanatorio Británico. Servicio de Reumatología; ArgentinaFil: Pisoni, Cecilia N. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno. Sección Reumatología e Inmunología; ArgentinaFil: Juárez, Vicente. Hospital Señor Del Milagro; ArgentinaFil: Cosatti, Micaela Ana. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno. Sección Reumatología e Inmunología; ArgentinaFil: Aste, Nora María. Reumatología; ArgentinaFil: Airoldi, Carla. Hospital Provincial. Reumatología; ArgentinaFil: Llanos, Carolina. Pontificia Universidad Católica de Chile. Departamento de Inmunología Clínica y Reumatología; ArgentinaFil: Vergara Melian, Cristian Fabián. Hospital San Martin de Quillota; ChileFil: Vergara Melian, Cristian Fabián. Clinica Ciudad Del Mar; ChileFil: Erlij Opazo, Daniel. Universidad de Chile. Hospital Del Salvador. Departamento de Medicina Oriente; ChileFil: Goecke, Annelise. Hospital Clínico Universidad de Chile. Departamento de Medicina. Servicio de Reumatología; ChileFil: Pastenes Montaño, Paula Andrea. Hospital Carlos Van Buren. Servicio de Medicina. Departamento de Reumatología; ChileFil: Tate, Patricio. Organización Médica de Investigación; ArgentinaFil: Pirola, Juan Pablo. Sanatorio Argentino; ArgentinaFil: Stange Núñez, Lilith. Clínica Ciudad Del Mar. Centro de Artritis Reumatoide; ChileFil: Burgos, Paula I. Pontificia Universidad Católica de Chile. Departamento de Inmunología Clínica y Reumatología; ChileFil: Mezzano Robinson, María Verónica. Hospital Del Salvador. Clínica Las Condes; ChileFil: Michalland H, Susana. Universidad de Chile. Hospital Del Salvador. Sección Reumatología; ChileFil: Silva Labra, Francisco. Hospital Padre Hurtado. Facultad de Medicina Clínica Alemana-Universidad Del Desarrollo; ChileFil: Labarca Solar, Cristián Humberto. Hospital Padre Hurtado. Facultad de Medicina Clínica Alemana-Universidad Del Desarrollo; ChileFil: Lencina, María Verónica. Hospital Señor Del Milagro; ArgentinaFil: Izquierdo Loaiza, Jorge Hernán. Clínica de Occidente S.A. Grupo de Reumatología; ColombiaFil: Del Castillo Gil, David Julián. Clínica de Occidente S.A. Grupo de Reumatología; ColombiaFil: Caeiro, Francisco. Hospital Privado Universitario de Córdoba. Servicio de Reumatología; ArgentinaFil: Paira, Sergio. Hospital José María Cullen. Sección de Reumatología; Argentin

Outpatient Parenteral Antibiotic Treatment for Infective Endocarditis: A Prospective Cohort Study From the GAMES Cohort

BACKGROUND: Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT). METHODS: Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed. RESULTS: A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09-.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22-.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission. CONCLUSIONS: OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded