Prognostic stratification of patients with left-sided endocarditis determined at admission

BACKGROUND: The prognosis of patients with left-sided endocarditis remains poor despite the progress of surgical techniques. Identification of high-risk patients within the first days after admission to the hospital would permit a more aggressive therapeutic approach. METHODS: We designed a prospective multicenter study to find out the clinical, microbiologic, and echocardiographic characteristics available within 72 hours of admission that might define the profile of high-risk patients. Of 444 episodes, 317 left-sided endocarditis cases were included and 76 variables were assessed. Events were surgery in the active phase of the disease and in-hospital death. A stepwise logistic regression analysis was undertaken to determine variables predictive of events. RESULTS: Multivariate analysis of the clinical variables found to have statistical significance in the univariate analysis identified the following as predictive: patient referred from another hospital ( odds ratio [OR]: 1.8; confidence interval [CI], 1.1-2.9), atrioventricular block ( OR: 2.5; CI, 1.1-5.9), acute onset ( OR: 1.7; CI, 1.1-2.9), and heart failure at admission ( OR: 2.3; CI, 1.4-3.8). When the echocardiographic and microbiological variables statistically significant in the univariate analysis were introduced, the presence of heart failure at admission ( OR: 2.9; CI, 1.8-4.8), periannular complications ( OR: 1.8; CI, 1.1-3.1), and Staphylococcus aureus infection ( OR: 2.0; CI, 1.1-3.8) retained prognostic power. Risk could be accurately stratified when combining the 3 variables with predictive power: 0 variables present: 25% of risk; 1 variable present: 38% to 49% of risk; 2 variables present: 56% to 66% of risk; and 3 variables present: 79% of risk. CONCLUSIONS: The risk of patients with left-sided endocarditis can be accurately stratified with the assessment of variables easily available within 72 hours of admission to the hospital. (c) 2007 Elsevier Inc. All rights reserved.