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

Dynamic capabilities and environmental accounting for the circular economy in businesses

Purpose: This paper aims to define and measure the environmental capabilities that are applied when the circular economy (CE) is introduced in businesses. Founded on the dynamic capabilities theoretical approach, the study analyzes different environmental competences that firms apply during this process. Environmental management systems, corporate social responsibility, reporting and accountability and other environmental accounting practices are studied in the same analytical framework used to study the environmental capabilities that influence the circular scope (CS) of firms. This study contributes to bridging the gap between academic research focused on environmental accounting and that investigating the introduction of the CE in businesses. Design/methodology/approach: The results were obtained by using partial least squares structural equation modeling to analyze the relationship between environmental capabilities for the CE and the CS achieved by a sample of Spanish firms with more than 50 employees that expressed interest in the CE, eco-design, eco-innovation and other environmental issues. Findings: Based on an analysis using the dynamic capabilities theoretical approach, the results suggest a positive relationship between the CS of firms, their environmental accounting practices and their level of corporate social responsibility (CSR) and accountability. Stakeholders’ pressure – which has a mediating effect on the CS of firms – is also analyzed, adding new insights to recent studies of this topic at the micro-level. The authors also explore whether the CS of businesses, which is related to the degree of their development of capabilities, influences environmental and financial performance. Practical implications: The new insights obtained in this study can help overcome the limitations of conventional accounting approaches and incorporates a much broader scale of environmental information that can be applied to CE practices. These results also offer insights to practitioners regarding the internal measurement processes related to the CE and regarding CSR in particular for small and medium enterprises, because these metrics can be partially applied depending on the practices introduced in each firm. For policymakers, a better understanding of the CE’s introduction into businesses will contribute to the design of policies that can enhance its deployment, for example, by providing tools that set up regional priorities depending on the CE-related practices adopted by the firms located in the territory. Social implications: A CE involves the transformation of a linear economic model into a circular one to reduce dependence on raw materials and energy and to reduce the environmental impact of production and consumption. Understanding how to manage the specific competences that integrate capabilities applied to the CE will allow firms to improve their social and environmental reporting. In addition, other social implications of this study relate to improving relationships with consumers and stakeholders and to the practice of social corporate sustainability. Originality/value: This study goes beyond previous research on the CE to extend the authors’ knowledge about its adoption at the micro-level by taking a transversal approach, as its subject spans the fields of environmental accounting and the CE while addressing both in a framework of analysis. The analysis of the accounting concerns of the CE in businesses and the study of concerns related to endogenous environmental competences are quite original under the theoretical framework of dynamic capabilities, and this study is a first step in an incipient line of inquiry. © 2020, Sabina Scarpellini, Luz María Marín-Vinuesa, Alfonso Aranda-Usón and Pila Portillo-Tarragona

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

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. 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: A total of 3120 patients with IE (1327  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 th

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective