Saito Fumiya, Toyoda Shigeru, Arikawa Takuo, Inami Shu, Watanabe Ryo, Obi Syotaro, Sakuma Masashi, Kanaya Tomoaki, Abe Shichiro, Nakajima Toshiaki, Inoue Teruo
Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, Japan.
Intern Med. 2019 Aug 15;58(16):2323-2331. doi: 10.2169/internalmedicine.1813-18. Epub 2019 May 22.
Objective Embolic events are frequent and life-threatening complications of infective endocarditis (IE). Recently, an embolic risk assessment at admission, based on the Embolic Risk (ER) French Calculator, was designed to predict the development of symptomatic emboli associated with IE. This study aimed to validate the ER French Calculator for the prediction of in-hospital events, including embolic events. Methods We retrospectively analyzed the clinical features of 52 consecutive patients with left-sided IE to identify possible predictors of in-hospital events within 30 days of admission. Results New embolic events were seen in 15 patients (29%), cardiac surgery was performed in 22 patients (42%), and 1 patient (2%) died within 30 days of admission. A composite endpoint of embolic complications, cardiac surgery, or death was observed in 28 patients (54%). The cumulative incidence of new embolic events was significantly higher in the high-risk group identified by the ER French Calculator than in the low-risk group (log-rank test; p=0.0004). The incidence of the composite endpoint was higher in the high-risk group than in the low-risk group (log-rank test; p<0.0001). A multivariate Cox proportional hazards model indicated that the high-risk designation on the ER French Calculator predicted embolic events (p=0.0410) and composite events (p=0.0371) independently of other candidate predictors. Conclusion The ER French Calculator may be a useful tool for predicting new in-hospital embolic events and other unfavorable in-hospital events in patients with IE.
目的 栓塞事件是感染性心内膜炎（IE）常见且危及生命的并发症。最近，基于法国栓塞风险（ER）计算器设计了一种入院时的栓塞风险评估方法，用于预测与IE相关的有症状栓塞的发生。本研究旨在验证法国ER计算器对包括栓塞事件在内的院内事件的预测能力。方法 我们回顾性分析了52例连续性左侧IE患者的临床特征，以确定入院后30天内院内事件的可能预测因素。结果 15例患者（29%）出现新的栓塞事件，22例患者（42%）接受了心脏手术，1例患者（2%）在入院后30天内死亡。28例患者（54%）观察到栓塞并发症、心脏手术或死亡的复合终点。法国ER计算器确定的高危组中新发栓塞事件的累积发生率显著高于低危组（对数秩检验；p=0.0004）。高危组复合终点的发生率高于低危组（对数秩检验；p<0.0001）。多因素Cox比例风险模型表明，法国ER计算器上的高危判定独立于其他候选预测因素，可预测栓塞事件（p=0.0410）和复合事件（p=0.0371）。结论 法国ER计算器可能是预测IE患者院内新发栓塞事件和其他不良院内事件的有用工具。
