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

Armiñanzas, C. ; Fariñas-Alvarez, C. ; Zarauza, J. ; Muñoz, P. ; González Ramallo, V. ; Martínez Sellés, M. ; Miró Meda, J.M. ; Pericás, J.M. ; Goenaga, M.Á. ; Ojeda Burgos, G. ; Rodríguez Álvarez, R. ; Castelo Corral, L. ; Gálvez-Acebal, J. ; Martínez Marcos, F.J. ; Fariñas, M.C. ; Fernández Sánchez, F. ; Noureddine, M. ; Rosas, G. ; de la Torre Lima, J. ; Aramendi, J. ; Bereciartua, E. ; Blanco, M.J. ; Blanco, R. ; Boado, M.V. ; Campaña Lázaro, M. ; Crespo, A. ; Goikoetxea, J. ; Iruretagoyena, J.R. ; Irurzun Zuazabal, J. ; López-Soria, L. ; Montejo, M. ; Nieto, J. ; Rodrigo, D. ; Rodríguez, D. ; Rodríguez, R. ; Vitoria, Y. ; Voces, R. ; García López, M.V. ; Georgieva, R.I. ; Ojeda, G. ; Rodríguez Bailón, I. ; Ruiz Morales, J. ; Cuende, A.M. ; Echeverría, T. ; Fuerte, A. ; Gaminde, E. ; Idígoras, P. ; Iribarren, J.A. ; Izaguirre Yarza, A. ; Kortajarena Urkola, X. ; Reviejo, C. ; Carrasco, R. ; Climent, V. ; Llamas, P. ; Merino, E. ; Plazas, J. ; Reus, S. ; Álvarez, N. ; Bravo-Ferrer, J.M. ; Castelo, L. ; Cuenca, J. ; Llinares, P. ; Miguez Rey, E. ; Rodríguez Mayo, M. ; Sánchez, E. ; Sousa Regueiro, D. ; Martínez, F.J. ; Alonso, M.D.M. ; Castro, B. ; García Rosado, D. ; Durán, M.D.C. ; Miguel Gómez, M.A. ; Lacalzada, J. ; Nassar, I. ; Plata Ciezar, A. ; Reguera Iglesias, J.M. ; Asensi Álvarez, V. ; Costas, C. ; de la Hera, J. ; Fernández Suárez, J. ; Iglesias Fraile, L. ; León Arguero, V. ; López Menéndez, J. ; Mencia Bajo, P. ; Morales, C. ; Moreno Torrico, A. ; Palomo, C. ; Paya Martínez, B. ; Rodríguez Esteban, Á. ; Rodríguez García, R. ; Telenti Asensio, M. ; Almela, M. ; Ambrosioni, J. ; Azqueta, M. ; Brunet, M. ; Bodro, M. ; Cartañá, R. ; Falces, C. ; Fita, G. ; Fuster, D. ; García de la Mària, C. ; Hernández-Meneses, M. ; Llopis Pérez, J. ; Marco, F. ; Miró, J.M. ; Moreno, A. ; Nicolás, D. ; Ninot, S. ; Quintana, E. ; Paré, C. ; Pereda, D. ; Pericás, J.M. ; Pomar, J.L. ; Ramírez, J. ; Rovira, I. ; Sandoval, E. ; Sitges, M. ; Soy, D. ; Téllez, A. ; Tolosana, J.M. ; Vidal, B. ; Vila, J. ; Adán, I. ; Bermejo, J. ; Bouza, E. ; Celemín, D. ; Cuerpo Caballero, G. ; Delgado Montero, A. ; Fernández Cruz, A. ; García Mansilla, A. ; García Leoni, M.E. ; Kestler Hernández, M. ; Hualde, A.M. ; Marín, M. ; Martínez-Sellés, M. ; Menárguez, M.C. ; Rincón, C. ; Rodríguez-Abella, H. ; Rodríguez-Créixems, M. ; Pinilla, B. ; Pinto, Á. ; Valerio, M. ; Vázquez, P. ; Verde Moreno, E. ; Antorrena, I. ; Loeches, B. ; Martín Quirós, A. ; Moreno, M. ; Ramírez, U. ; Rial Bastón, V. ; Romero, M. ; Saldaña, A. ; Agüero Balbín, J. ; Amado, C. ; Armiñanzas Castillo, C. ; Arnaiz García, A. ; Cobo Belaustegui, M. ; Fariñas, M.C. ; Fariñas-Álvarez, C. ; Gómez Izquierdo, R. ; García, I. ; González-Rico, C. ; Gutiérrez-Cuadra, M. ; Gutiérrez Díez, J. ; Pajarón, M. ; Parra, J.A. ; Sarralde, A. ; Teira, R. ; Domínguez, F. ; García Pavía, P. ; González, J. ; Orden, B. ; Ramos, A. ; Centella, T. ; Hermida, J.M. ; Moya, J.L. ; Martín-Dávila, P. ; Navas, E. ; Oliva, E. ; del Río, A. ; Ruiz, S. ; Hidalgo Tenorio, C. ; Almendro Delia, M. ; Araji, O. ; Barquero, J.M. ; Calvo Jambrina, R. ; de Cueto, M. ; Gálvez Acebal, J. ; Méndez, I. ; Morales, I. ; Matamala Adell, M. (Universidad de Zaragoza)

Resumen: 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 years, 65 to 80 years, and = 80 years.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 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality.
Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, 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.

Idioma: Inglés

DOI: 10.1016/j.ejim.2019.03.006

Año: 2019

Publicado en: EUROPEAN JOURNAL OF INTERNAL MEDICINE 64 (2019), 63-71
ISSN: 0953-6205

Factor impacto JCR: 4.329 (2019)

Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 26 / 165 = 0.158 (2019) - Q1 - T1

Factor impacto SCIMAGO: 1.017 - Internal Medicine (Q2)

Tipo y forma: Artículo (PostPrint)

Área (Departamento): Área Cirugía (Dpto. Cirugía,Ginecol.Obstetr.)