title: Usefulness of thrombocytopenia at admission as a prognostic marker in native valve left-sided infective endocarditis.
abstract: In-hospital mortality of patients with infective endocarditis (IE) remains exceedingly high. Quick recognition of parameters accurately identifying high-risk patients is of paramount importance. The objective of this study was to analyze the incidence and severity of thrombocytopenia at presentation and its prognostic impact in patients with native valve left-sided IE. We studied a cohort of 533 consecutive episodes of native valve left-sided IE prospectively recruited. We distinguished 2 groups: group I (n = 175), episodes who had thrombocytopenia at admission, and group II (n = 358) gathered all the episodes who did not. Thrombocytopenia at admission was defined as a platelet count of <150,000/μl. No differences were found in the need for surgery, but in-hospital mortality was significantly higher in patients with thrombocytopenia (p <0.001). Mortality rate was associated with the degree of thrombocytopenia (p <0.001). In the multivariable analysis, thrombocytopenia at admission was an independent predictor of higher mortality (p = 0.002). A synergistic interaction between thrombocytopenia and Staphylococcus aureus on mortality risk was also observed (p = 0.04). In conclusion, thrombocytopenia at admission is an early risk marker of increased mortality in patients with native valve left-sided IE. Mortality rates increased with increasing severity of thrombocytopenia. Thrombocytopenia at admission should be used as an early marker for risk stratification in patients with native valve IE to identify those at risk of complicated in-hospital evolution and increased mortality.
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: carlosferreraduran@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferrera
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.affiliation: Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, Valladolid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: López
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sarriá
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Olmos
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Vivas
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sáez
authors.affiliation: Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sánchez-Enrique
authors.affiliation: Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, Valladolid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ortiz
authors.affiliation: Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, Valladolid, Spain.
authors.forename: José Alberto
authors.initials: JA
authors.lastname: San Román
mesh_terms: D004696:Endocarditis / Q000097:blood / Q000150:complications* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013921:Thrombocytopenia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*