What is the clinical evidence from this study?

Study design: Cohort. Population: Infective endocarditis (n=726). Intervention: Charlson Comorbidity Index (CCI) ≥ 3 vs. CCI < 3. Primary outcome: 1-year mortality (HR 1.34, 95% CI 1.08-1.66, p=0.007).

June 29, 2022Journal of Clinical Medicine15 citationsOpen Access

Comorbidity and Prognosis in Octogenarians with Infective Endocarditis

Q: What are the key findings of this study?

In octogenarians with infective endocarditis, high comorbidity (CCI ≥ 3) independently predicted 1-year mortality (HR 1.34; 95% CI 1.08-1.66; p=0.007).

JPJose-Ángel Pérez-Rivera CACarlos Armiñanzas PMPatricia Muñóz

Key Result

In octogenarians with infective endocarditis, high comorbidity (CCI ≥ 3) independently predicted 1-year mortality (HR 1.34; 95% CI 1.08-1.66; p=0.007).

Study Design

Type

Cohort (n=726)

Multicenter

Yes

Structured PICO

Does high comorbidity (CCI ≥ 3) predict higher mortality in octogenarians with infective endocarditis?

Population

726 patients aged ≥ 80 years with definite infective endocarditis from a Spanish prospective database, followed for 1 year.

Exposure

High comorbidity (Charlson Comorbidity Index [CCI] ≥ 3)

Comparator

Low comorbidity (Charlson Comorbidity Index [CCI] < 3)

Outcome

In-hospital and 12-month mortalityhard clinical

In octogenarians with infective endocarditis, high comorbidity (CCI ≥ 3) independently predicts in-hospital and 1-year mortality, while cardiac surgery appears underutilized despite its association with lower mortality.

Main Result

Hazard Ratio: 1.34 (95% CI 1.08–1.66)

p-value: p=0.007

Abstract

Background. Infective endocarditis (IE) in older patients is associated with a high morbidity, mortality, and functional impairment. The purpose of this study was to describe the current profile of IE in octogenarians and to analyze the prognostic impact of baseline comorbidities in this population. Methods. Patients ≥ 80 years and definite IE from the Spanish IE Prospective Database were included. The effect of Charlson Comorbidity Index (CCI) on in-hospital and 12-month mortality was analyzed. Results. From 726 patients, 357 (49%) had CCI ≥ 3 and 369 (51%) CCI < 3. A total of 265 patients (36.6%) died during hospital admission and 338 (45.5%) during 1-year follow-up. CCI ≥ 3 was an independent predictor of in-hospital and 1-year mortality (odds ratio 1.46, 95% confidence interval 1.07−1.99, p = 0.017; hazard ratio 1.34, 95% confidence interval 1.08−1.66, p = 0.007, respectively). Surgical management was less common in patients with high comorbidity (CCI ≥ 3 68 19.0% vs. CCI < 3 112 ((30.4%) patients, p < 0.01). From 443 patients with surgical indication, surgery was only performed in 176 (39.7%). Patients with surgical indication treated conservatively had higher mortality than those treated with surgery (in-hospital mortality: 147 (55.1%) vs. 55 (31.3%), p < 0.001), (1-year mortality: 172 (64.4%) vs. 68 38.6%, p < 0.001). Conclusion. About half of octogenarians with IE had high comorbidity with CCI ≥ 3. CCI ≥ 3 was a strong independent predictor of in-hospital and 1-year mortality. Our data suggest that the underperformance of cardiac surgery in this group of patients might have a role in their poor prognosis.

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