title: Age adjusted Charlson Co-morbidity Index is an independent predictor of mortality over long-term follow-up in infective endocarditis.
abstract: BACKGROUND
  Infective endocarditis (IE) is associated with high morbidity and mortality. The epidemiology of IE is changing, affecting more elderly patients with increased medical comorbidities. We aimed to assess the ability of the age adjusted Charlson Co-morbidity Index (ACCI) to predict early and late outcomes.
  
  
  METHODS
  Between 1998 and 2010, adult patients with definite IE according to the modified Duke criteria were identified. The primary outcome was in-hospital and all-cause mortality. The secondary outcome was predictors of the primary outcome incorporating ACCI.
  
  
  RESULTS
  148 patients with IE were followed up for a mean of 3.8 ± 3 years. The mean age was 57 ± 17 years and 66% were male. In-hospital mortality and all-cause mortality were 24 and 47% respectively. Comorbid conditions included diabetes mellitus (DM) (21%); ischaemic heart disease (16%); heart failure (HF) (14%); renal failure (eGFR <60 ml/min/1.73 m(2)) (19%); and anaemia (64%). The most common causative organism was Staphylococcus aureus (53%). ACCI was >3 in 59% of patients. Cardiac surgery was performed in 45% of patients. On Cox regression analysis, ACCI >3 (HR=3.0 [1.5-6.0], p<0.002), new onset HF (HR=2.2 [1.3-3.6], p<0.003), anaemia (HR=1.8 [1.1-3.2], p=0.04) and age-per decade (HR=1.4 [1.1-1.7]. p=0.004) were independently associated with all-cause mortality. ACCI >3 was the strongest predictor of in-hospital mortality (OR=8.4 [2.8-24], p<0.001). Of the individual ACCI components, prior HF, DM with complications and metastatic disease were independent predictors of all-cause mortality.
  
  
  CONCLUSIONS
  In-hospital and all-cause mortality of IE remain high. An ACCI >3 was a strong predictor of mortality, in addition to age, new HF and anaemia.
authors: Department of Medicine, University of Melbourne and Austin Health, Victoria, Australia; Department of Cardiology, Austin Health, Victoria, Australia. Electronic address: ken.lu@austin.org.au.
authors: K J
authors: KJ
authors: Lu
authors: L G
authors: LG
authors: Kearney
authors: M
authors: M
authors: Ord
authors: E
authors: E
authors: Jones
authors: L M
authors: LM
authors: Burrell
authors: P M
authors: PM
authors: Srivastava
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000740:Anemia / Q000401:mortality; D015897:Comorbidity; D004697:Endocarditis, Bacterial / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000401:mortality*; D013290:Streptococcal Infections / Q000401:mortality*
keywords: Charlson Co-morbidity Index; Infective endocarditis; Mortality