on March 22, 2004
Circulation. 2004
Published online before print March 22, 2004, doi: 10.1161/01.CIR.0000124719.61827.7F
Published online before print March 22, 2004, doi: 10.1161/01.CIR.0000124719.61827.7F
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Submitted on August 22, 2003
From the Department of Medicine, Duke University Medical Center, Durham, NC. * To whom correspondence should be addressed. E-mail: a.wang{at}duke.edu.
Background--Data on early determinants of outcome in infective endocarditis (IE) are limited. We evaluated the prognostic significance of early clinical characteristics in a large, prospective cohort of patients with IE. Methods and Results--Two hundred sixty-seven consecutive patients with definite or possible IE by modified Duke criteria and echocardiography performed within 7 days of presentation were evaluated. Acute physiology was assessed by the Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score at the time of presentation, and early heart failure was diagnosed by Framingham criteria. In-hospital mortality rate in the cohort was 19% and similar for patients with definite or possible IE (20% versus 16%, respectively; P=0.464). Independent predictors of death determined by logistic regression modeling were diabetes mellitus (OR 2.48; 95% CI, 1.24 to 4.96), Staphylococcus aureus as causative organism (OR, 2.06; 95% CI, 1.01 to 4.20), APACHE II score (OR, 1.07; 95% CI, 1.01 to 1.12), and embolic event (OR, 2.79; 95% CI, 1.15 to 6.80). Early echocardiographic findings of the Duke criteria were not predictive of death. Conclusions--Early in the course of IE, readily available clinical characteristics that reflect the host-pathogen interaction are predictive of in-hospital death. These factors may identify those patients with IE for more aggressive treatment.
Revised on January 13, 2004
Accepted on January 14, 2004
Early Predictors of In-Hospital Death in Infective Endocarditis
Vivian H. Chu MD,
Key words: endocardium • prognosis • infection • valves • echocardiography
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