Role of age and comorbidities in mortality of patients with infective endocarditis

doi:10.1016/j.ejim.2019.03.006

Role of age and comorbidities in mortality of patients with infective endocarditis

Department of Medicine

Research output: Contribution to journal › Article › Research › peer-review

Abstract

PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality.

METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk.

RESULTS: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality.

CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.

Original language	English
Pages (from-to)	63-71
Number of pages	9
Journal	European Journal of Internal Medicine
Volume	64
DOIs	https://doi.org/10.1016/j.ejim.2019.03.006
Publication status	Published - Jun 2019

Keywords

Adult
Age Factors
Aged
Aged, 80 and over
Area Under Curve
Comorbidity
Databases, Factual
Endocarditis/etiology
Female
Heart Failure/mortality
Hospital Mortality
Humans
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
ROC Curve
Risk Factors
Spain/epidemiology
Staphylococcal Infections/mortality

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@article{ab4092fafe4e47cabd197fef656a67a0,

title = "Role of age and comorbidities in mortality of patients with infective endocarditis",

abstract = "PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality.METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk.RESULTS: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality.CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.",

keywords = "Adult, Age Factors, Aged, Aged, 80 and over, Area Under Curve, Comorbidity, Databases, Factual, Endocarditis/etiology, Female, Heart Failure/mortality, Hospital Mortality, Humans, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, ROC Curve, Risk Factors, Spain/epidemiology, Staphylococcal Infections/mortality",

author = "Carlos Armi{\~n}anzas and Concepci{\'o}n Fari{\~n}as-Alvarez and Jes{\'u}s Zarauza and Patricia Mu{\~n}oz and {Gonz{\'a}lez Ramallo}, V{\'i}ctor and {Mart{\'i}nez Sell{\'e}s}, Manuel and {Mir{\'o} Meda}, {Jos{\'e} Mª} and Peric{\'a}s, {Juan Manuel} and Goenaga, {Miguel {\'A}ngel} and {Ojeda Burgos}, Guillermo and {Rodr{\'i}guez {\'A}lvarez}, Regino and {Castelo Corral}, Laura and Juan G{\'a}lvez-Acebal and {Mart{\'i}nez Marcos}, {Francisco Javier} and Fari{\~n}as, {Maria Carmen} and {Fern{\'a}ndez S{\'a}nchez}, Fernando and Mariam Noureddine and Gabriel Rosas and {de la Torre Lima}, Javier and Jos{\'e} Aramendi and Elena Bereciartua and Blanco, {Mar{\'i}a Jos{\'e}} and Roberto Blanco and Boado, {Mar{\'i}a Victoria} and {Campa{\~n}a L{\'a}zaro}, Marta and Alejandro Crespo and Josune Goikoetxea and Iruretagoyena, {Jos{\'e} Ram{\'o}n} and {Irurzun Zuazabal}, Josu and Leire L{\'o}pez-Soria and Miguel Montejo and Javier Nieto and David Rodrigo and David Rodr{\'i}guez and Regino Rodr{\'i}guez and Yolanda Vitoria and Roberto Voces and {Garc{\'i}a L{\'o}pez}, {Mª Victoria} and Georgieva, {Radka Ivanova} and Guillermo Ojeda and {Rodr{\'i}guez Bail{\'o}n}, Isabel and {Ruiz Morales}, Josefa and Cuende, {Ana Mar{\'i}a} and Tom{\'a}s Echeverr{\'i}a and Ana Fuerte and Eduardo Gaminde and Goenaga, {Miguel {\'A}ngel} and Pedro Id{\'i}goras and Iribarren, {Jos{\'e} Antonio} and {de Benito}, Natividad",

note = "Copyright {\textcopyright} 2019. Published by Elsevier B.V.",

year = "2019",

month = jun,

doi = "10.1016/j.ejim.2019.03.006",

language = "English",

volume = "64",

pages = "63--71",

journal = "European Journal of Internal Medicine",

issn = "0953-6205",

}

TY - JOUR

T1 - Role of age and comorbidities in mortality of patients with infective endocarditis

AU - Armiñanzas, Carlos

AU - Fariñas-Alvarez, Concepción

AU - Zarauza, Jesús

AU - Muñoz, Patricia

AU - González Ramallo, Víctor

AU - Martínez Sellés, Manuel

AU - Miró Meda, José Mª

AU - Pericás, Juan Manuel

AU - Goenaga, Miguel Ángel

AU - Ojeda Burgos, Guillermo

AU - Rodríguez Álvarez, Regino

AU - Castelo Corral, Laura

AU - Gálvez-Acebal, Juan

AU - Martínez Marcos, Francisco Javier

AU - Fariñas, Maria Carmen

AU - Fernández Sánchez, Fernando

AU - Noureddine, Mariam

AU - Rosas, Gabriel

AU - de la Torre Lima, Javier

AU - Aramendi, José

AU - Bereciartua, Elena

AU - Blanco, María José

AU - Blanco, Roberto

AU - Boado, María Victoria

AU - Campaña Lázaro, Marta

AU - Crespo, Alejandro

AU - Goikoetxea, Josune

AU - Iruretagoyena, José Ramón

AU - Irurzun Zuazabal, Josu

AU - López-Soria, Leire

AU - Montejo, Miguel

AU - Nieto, Javier

AU - Rodrigo, David

AU - Rodríguez, David

AU - Rodríguez, Regino

AU - Vitoria, Yolanda

AU - Voces, Roberto

AU - García López, Mª Victoria

AU - Georgieva, Radka Ivanova

AU - Ojeda, Guillermo

AU - Rodríguez Bailón, Isabel

AU - Ruiz Morales, Josefa

AU - Cuende, Ana María

AU - Echeverría, Tomás

AU - Fuerte, Ana

AU - Gaminde, Eduardo

AU - Goenaga, Miguel Ángel

AU - Idígoras, Pedro

AU - Iribarren, José Antonio

AU - de Benito, Natividad

PY - 2019/6

Y1 - 2019/6

N2 - PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality.METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk.RESULTS: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality.CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.

AB - PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality.METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk.RESULTS: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality.CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Area Under Curve

KW - Comorbidity

KW - Databases, Factual

KW - Endocarditis/etiology

KW - Female

KW - Heart Failure/mortality

KW - Hospital Mortality

KW - Humans

KW - Male

KW - Middle Aged

KW - Proportional Hazards Models

KW - Prospective Studies

KW - ROC Curve

KW - Risk Factors

KW - Spain/epidemiology

KW - Staphylococcal Infections/mortality

U2 - 10.1016/j.ejim.2019.03.006

DO - 10.1016/j.ejim.2019.03.006

M3 - Article

C2 - 30904433

VL - 64

SP - 63

EP - 71

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

ER -