title: Prediction of symptomatic embolism in infective endocarditis: construction and validation of a risk calculator in a multicenter cohort.
abstract: OBJECTIVE
  The aim of this study was to develop and validate a simple calculator to quantify the embolic risk (ER) at admission of patients with infective endocarditis.
  
  
  BACKGROUND
  Early valve surgery reduces the incidence of embolism in high-risk patients with endocarditis, but the quantification of ER remains challenging.
  
  
  METHODS
  From 1,022 consecutive patients presenting with definite diagnoses of infective endocarditis in a multicenter observational cohort study, 847 were randomized into derivation (n = 565) and validation (n = 282) samples. Clinical, microbiological, and echocardiographic data were collected at admission. The primary endpoint was symptomatic embolism that occurred during the 6-month period after the initiation of treatment. The prediction model was developed and validated accounting for competing risks.
  
  
  RESULTS
  The 6-month incidence of embolism was similar in the development and validation samples (8.5% in the 2 samples). Six variables were associated with ER and were used to create the calculator: age, diabetes, atrial fibrillation, embolism before antibiotics, vegetation length, and Staphylococcus aureus infection. There was an excellent correlation between the predicted and observed ER in both the development and validation samples. The C-statistics for the development and validation samples were 0.72 and 0.65, respectively. Finally, a significantly higher cumulative incidence of embolic events was observed in patients with high predicted ER in both the development (p < 0.0001) and validation (p < 0.05) samples.
  
  
  CONCLUSIONS
  The risk for embolism during infective endocarditis can be quantified at admission using a simple and accurate calculator. It might be useful for facilitating therapeutic decisions.
authors.affiliation: Département de Cardiologie Hôpital Universitaire de la Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France; Service de Chirurgie Cardiaque, Hôpital Universitaire de la Timone, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Hubert
authors.forename: Franck
authors.initials: F
authors.lastname: Thuny
authors.forename: Noemie
authors.initials: N
authors.lastname: Resseguier
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: Yvan
authors.initials: Y
authors.lastname: Le Dolley
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Casalta
authors.forename: Alberto
authors.initials: A
authors.lastname: Riberi
authors.forename: Florent
authors.initials: F
authors.lastname: Chevalier
authors.forename: Dan
authors.initials: D
authors.lastname: Rusinaru
authors.forename: Dorothée
authors.initials: D
authors.lastname: Malaquin
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Remadi
authors.forename: Ammar Ben
authors.initials: AB
authors.lastname: Ammar
authors.forename: Jean Francois
authors.initials: JF
authors.lastname: Avierinos
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004452:Echocardiography; D004617:Embolism / Q000453:epidemiology* / Q000628:therapy; D004697:Endocarditis, Bacterial / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000628:therapy; D011897:Random Allocation; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000453:epidemiology; D013211:Staphylococcus aureus
chemical_list: D000900:Anti-Bacterial Agents
keywords: CI; ER; confidence interval; embolic risk; embolism; endocarditis; prognosis