Predictors of mortality in paravalvular abscess.
BACKGROUND
Paravalvular abscess formation is an ominous complication of infective endocarditis; however, prognostic variables in paravalvular abscess are poorly defined.


METHODS
We examined our experience in patients with paravalvular abscess between 1987 and 2004. Clinical, echocardiographic, microbiologic, and surgical data were examined.


RESULTS
There were 45 patients (17 females), age 57 +/- 17 years. Twenty-four patients had prosthetic valve endocarditis. Methicillin-sensitive Staphylococcus aureus and coagulase-negative S. aureus were the most common organisms accounting for 25 (56%) cases. Thirty-eight patients (84%) underwent surgery during initial admission. Surgical mortality was 7%, in-hospital mortality was 31%, and 1-year mortality was 38%. Between patients who died and patients who survived, there were no differences in age (61 +/- 20 years vs 55 +/- 15 years, P = .3), type of microorganism, presence of prosthetic heart valves (47% vs 57%), presence of moderate to severe or severe regurgitation of involved valve (47% vs 57%, P = .37), presence of associated valvular vegetation (93% vs 93%), area of abscess (5.6 +/- 2.9 cm2 vs 4.4 +/- 3.2 cm2, P = .39), left ventricular systolic function (56% +/- 13% vs 56% +/- 10%, P = .9), white cell count (13 +/- 4 vs 13 +/- 7, P = .9), or polymorphonuclear leukocytosis (86% +/- 6% vs 81% +/- 9%, P = .1). Patients who died were sicker on admission compared with those who survived (33% had stroke or altered mental status vs 7%, P = .03) and had worse renal function compared with those who survived (creatinine 4 +/- 4 mg/dL vs 1.6 +/- 1.9 mg/dL, P = .009).


CONCLUSIONS
Neurologic impairment and renal impairment are significant determinants of 1-year survival in patients who present with paravalvular abscess.
Naqvi
Tasneem Z
TZ
Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, California, USA. tasneem.naqvi@cshs.org
Boyatt
Jason
J
Siegel
Robert J
RJ
D000038:Abscess / Q000175:diagnosis* / Q000401:mortality*; D015897:Comorbidity; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000401:mortality; D016019:Survival Analysis; D015996:Survival Rate