title: Prognostic stratification of patients with left-sided endocarditis determined at admission.
abstract: 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.
authors.affiliation: Instituto de Ciencias del Corazón, Hospital Clínico Universitario, Valladolid, Spain. asanroman@secardiologia.es
authors.forename: José Alberto
authors.initials: JA
authors.lastname: San Román
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.forename: María
authors.initials: M
authors.lastname: Luaces
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarriá
authors.forename: Ana
authors.initials: A
authors.lastname: Revilla
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ronderos
authors.forename: Walter
authors.initials: W
authors.lastname: Stoermann
authors.forename: Itziar
authors.initials: I
authors.lastname: Gómez
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
mesh_terms: D001118:Argentina / Q000453:epidemiology; D002423:Cause of Death; D004696:Endocarditis / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis