title: Clinical and economic outcomes of infective endocarditis.
abstract: BACKGROUND
  In France, the estimated annual incidence of infective endocarditis (IE) is 33.8 cases per million residents. Valvular surgery is frequently undergone. We report an epidemiological and economic study of IE for 2007-2009 in a French region, using the hospital discharge database (HDD).
  
  
  METHODS
  The population studied concerned all the patients living in Centre region, France, hospitalized for IE. We extracted hospital stay data for IE from the regional HDD, with a definition based on IE-related diagnosis codes. The predictive positive value (PPV) and sensitivity (Se) of the definition were 87.4% and 90%, respectively, according to the Duke criteria (definite IE frequency 74.4%). Hospitalization costs were estimated, taking into account the fixed hospital charges of the diagnosis-related group (DRG) and supplementary charges due to intensive care unit (ICU) stay.
  
  
  RESULTS
  The analysis included 578 patients. The annual average incidence was 45.4 cases per million residents. Valvular surgery was performed in 19.4% of cases. The hospital mortality was 17.6%. Multivariate analysis identified as risk factors for mortality an age ≥ 70 years (odds ratio (OR) = 3.03, 95% confidence interval (CI) = 1.78-5.18), staphylococcal IE (OR = 3.3, 95% CI = 1.9-5.7), chronic renal insufficiency (OR = 2.04, 95% CI = 1.00-4.15), ischemic stroke (OR = 2.55, 95% CI = 1.19-5.47), and hemorrhagic stroke (OR = 5.7, 95% CI = 1.9-17.3). The average cost per episode was $20 103 (€15 281).
  
  
  CONCLUSIONS
  We report a higher incidence of IE than described by the French national study of 2008. Valvular surgery was considerably less frequent than in the published data, whereas mortality was similar. IE generates substantial costs.
authors.affiliation: From the Service de Médecine Interne et Maladies Infectieuses , CHRU de Tours, Tours , France.
authors.forename: Simon
authors.initials: S
authors.lastname: Sunder
authors.forename: Leslie
authors.initials: L
authors.lastname: Grammatico-Guillon
authors.forename: Sabine
authors.initials: S
authors.lastname: Baron
authors.forename: Christophe
authors.initials: C
authors.lastname: Gaborit
authors.forename: Anne
authors.initials: A
authors.lastname: Bernard-Brunet
authors.forename: Denis
authors.initials: D
authors.lastname: Garot
authors.forename: Annick
authors.initials: A
authors.lastname: Legras
authors.forename: Thierry
authors.initials: T
authors.lastname: Prazuck
authors.forename: Olivier
authors.initials: O
authors.lastname: Dibon
authors.forename: Thierry
authors.initials: T
authors.lastname: Boulain
authors.forename: Xavier
authors.initials: X
authors.lastname: Tabone
authors.forename: Yves
authors.initials: Y
authors.lastname: Guimard
authors.forename: Michel
authors.initials: M
authors.lastname: Massot
authors.forename: Antoine
authors.initials: A
authors.lastname: Valery
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Rusch
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002675:Child, Preschool; D003953:Diagnosis-Related Groups; D004696:Endocarditis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Infective endocarditis; cost; epidemiology; mortality; surgery