8 research outputs found

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

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    [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‚ÄĮyears,65 to 80‚ÄĮyears,and‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears.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‚ÄĮ<‚ÄĮ65‚ÄĮyears;1291 65-80‚ÄĮyears;502‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ‚Č•80‚ÄĮyears who underwent surgery were significantly lower compared with other age groups (14.3%,65‚ÄĮyears; 20.5%,65-79‚ÄĮyears; 31.3%,‚Č•80‚ÄĮyears). In-hospital mortality was lower in the <65-year group (20.3%,<65‚ÄĮyears;30.1%,65-79‚ÄĮyears;34.7%,‚Č•80‚ÄĮyears;p‚ÄĮ<‚ÄĮ0.001) as well as 1-year mortality (3.2%, <65‚ÄĮyears; 5.5%, 65-80‚ÄĮyears;7.6%,‚Č•80‚ÄĮyears; p‚ÄĮ=‚ÄĮ0.003).Independent predictors of mortality were age‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32‚Äď3.34), CCI‚ÄĮ‚Č•‚ÄĮ3 (HR:1.62; 95% CI:1.39‚Äď1.88),and non-performed surgery (HR:1.64;95% CI:11.16‚Äď1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65‚ÄĮyears(p‚ÄĮ<‚ÄĮ0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears, 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

    Birth Prevalence of Congenital Cytomegalovirus Infection in HIV-Exposed Uninfected Children in the Era of Combination Antiretroviral Therapy

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

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    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

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

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    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‚ÄĮ There were no differences in the clinical presentation of IE between the groups. Age‚ÄĮ‚Č•‚ÄĮ80‚ÄĮyears, 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

    Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse

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    Mural Endocarditis: The GAMES Registry Series and Review of the Literature

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