Hasbun Rodrigo, Vikram Holenarasipur R, Barakat Lydia A, Buenconsejo Joan, Quagliarello Vincent J
Infectious Disease Section, Tulane University School of Medicine, New Orleans, La, USA.
JAMA. 2003 Apr 16;289(15):1933-40. doi: 10.1001/jama.289.15.1933.
Complicated left-sided native valve endocarditis causes significant morbidity and mortality in adults. Lack of valid data regarding estimation of prognosis makes management of this condition difficult.
To derive and externally validate a prognostic classification system for adults with complicated left-sided native valve endocarditis.
DESIGN, SETTING, AND PATIENTS: Retrospective observational cohort study conducted from January 1990 to January 2000 at 7 Connecticut hospitals among 513 patients older than 16 years who experienced complicated left-sided native valve endocarditis and who were divided into derivation (n = 259) and validation (n = 254) cohorts.
All-cause mortality at 6 months after baseline.
In the derivation and validation cohorts, the 6-month mortality rates were 25% and 26%, respectively. Five baseline features were independently associated with 6-month mortality (comorbidity [P =.03], abnormal mental status [P =.02], moderate to severe congestive heart failure [P =.01], bacterial etiology other than viridans streptococci [P<.001 except Staphylococcus aureus, P =.004], and medical therapy without valve surgery [P =.002]) and were used to create a prognostic classification system. In the derivation cohort, patients were classified into 4 groups with increasing risk for 6-month mortality: 5%, 15%, 31%, and 59% (P<.001). In the validation cohort, a similar risk among the 4 groups was observed: 7%, 19%, 32%, and 69% (P<.001).
Adults with complicated left-sided native valve endocarditis can be accurately risk stratified using baseline features into 4 groups of prognostic severity. This prognostic classification system might be useful for facilitating management decisions.
成人复杂性左侧自体瓣膜心内膜炎会导致严重的发病和死亡。缺乏关于预后评估的有效数据使得这种疾病的管理变得困难。
推导并外部验证一种针对成人复杂性左侧自体瓣膜心内膜炎的预后分类系统。
设计、地点和患者：1990年1月至2000年1月在康涅狄格州的7家医院进行的回顾性观察队列研究，纳入513例年龄超过16岁且患有复杂性左侧自体瓣膜心内膜炎的患者，这些患者被分为推导队列（n = 259）和验证队列（n = 254）。
基线后6个月的全因死亡率。
在推导队列和验证队列中，6个月死亡率分别为25%和26%。五个基线特征与6个月死亡率独立相关（合并症[P = 0.03]、精神状态异常[P = 0.02]、中度至重度充血性心力衰竭[P = 0.01]、除草绿色链球菌外的细菌病因[除金黄色葡萄球菌外P < 0.001，P = 0.004]以及未进行瓣膜手术的药物治疗[P = 0.002]），并用于创建一个预后分类系统。在推导队列中，患者被分为4组，6个月死亡率风险逐渐增加：5%、15%、31%和59%（P < 0.001）。在验证队列中，观察到4组之间有类似的风险：7%、19%、32%和69%（P < 0.001）。
患有复杂性左侧自体瓣膜心内膜炎的成人可以使用基线特征准确地进行风险分层，分为4组预后严重程度不同的类别。这种预后分类系统可能有助于促进管理决策。
