RT Journal Article
SR Electronic
T1 Internal and external validation of a model to predict adverse outcomes in patients with left-sided infective endocarditis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1138
OP 1142
DO 10.1136/hrt.2010.200295
VO 97
IS 14
A1 López, Javier
A1 Fernández-Hidalgo, Nuria
A1 Revilla, Ana
A1 Vilacosta, Isidre
A1 Tornos, Pilar
A1 Almirante, Benito
A1 Sevilla, Teresa
A1 Gómez, Itziar
A1 Pozo, Eduardo
A1 Sarriá, Cristina
A1 San Román, José Alberto
YR 2011
UL http://heart.bmj.com/content/97/14/1138.abstract
AB Introduction Early identification of prognostic factors is essential to improve the grim prognosis associated with left-sided infective endocarditis. This group identified three independent risk factors obtained within 72 h of admission, (Staphylococcus aureus, heart failure and periannular complications) for inhospital mortality or urgent surgery in a series of 317 patients diagnosed at five tertiary centres (derivation sample). A stratification score was constructed for the test cohort by a simple arithmetic sum of the number of variables present. The goal was to validate this model internally and externally in a prospective manner with two different cohorts of patients.Methods The appropriateness of the model was tested prospectively on predicting events in two cohorts of patients with left-sided endocarditis: internally with the 263 consecutive patients diagnosed at the same centres where the model was derived (internal validation sample), and externally with 264 patients admitted at another hospital (external validation sample).Results The discriminatory power of the model, expressed as the area under the receiver operating characteristic curve was similar between derivation and both validation samples (internal 0.67 vs 0.68, p=0.79; external 0.67 vs p=0.74, p=0.09). There was a progressive, significant pattern of increasing event rates as the risk stratification score increased in both validation cohorts (p<0.001 by χ2 for trend).Conclusions The early risk stratification model derived, based on variables obtained within 72 h of admission, is applicable to different populations with left-sided endocarditis. A simple bedside assessment tool is provided to clinicians that identifies patients at high risk of having an adverse event.