In patients with S. aureus left-sided native valve endocarditis, intracardiac abscess independently predicted 1-year mortality (HR 2.25; 95% CI 1.26-3.78; P=0.004).
Cohort (n=727)
Yes
Do specific echocardiographic findings predict in-hospital and 1-year mortality in patients with left-sided native valve Staphylococcus aureus endocarditis?
In patients with left-sided native valve S. aureus endocarditis, specific echocardiographic findings including intracardiac abscess, LVEF <40%, and valve perforation are strong independent predictors of in-hospital and 1-year mortality.
Hazard Ratio: 2.25 (95% CI 1.26–3.78)
p-value: p=0.004
BACKGROUND: Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown. METHODS AND RESULTS: Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S aureus IE. One-year survival rates were significantly lower for patients with S aureus IE overall (57% S aureus IE versus 80% non-S aureus IE; P<0.001) and in the propensity-matched cohort (59% S aureus IE versus 68% non-S aureus IE; P<0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52-5.40; P<0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26-3.78; P=0.004) were the only independent predictors of 1-year mortality. CONCLUSIONS: S aureus is an independent predictor of 1-year mortality in subjects with LNVIE. In S aureus LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality.
Lauridsen et al. (Wed,) conducted a cohort in Left-sided native valve infective endocarditis (n=727). Intracardiac abscess vs. Absence of intracardiac abscess was evaluated on 1-year mortality (HR 2.25, 95% CI 1.26-3.78, p=0.004). In patients with S. aureus left-sided native valve endocarditis, intracardiac abscess independently predicted 1-year mortality (HR 2.25; 95% CI 1.26-3.78; P=0.004).
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