Embolic complications in a large contemporary cohort of infective endocarditis: do we need score model?

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-06-01 Epub Date: 2024-12-04 DOI:10.1007/s15010-024-02444-1

Lorenzo Bertolino, Ahsanullah Unar, Fabian Patauner, Raffaella Gallo, Anna Maria Carolina Peluso, Augusto Delle Femine, Oriana Infante, Silvia Mercadante, Fabio Luciano, Sabrina Manduca, Roberto Andini, Rosa Zampino, Emanuele Durante-Mangoni

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引用次数: 0

Abstract

Purpose: Infective endocarditis (IE) is a heterogeneous disease undergoing epidemiological changes. Whether those changes have an impact on the correlates of embolic events (EE) remains unclear. We analyzed the correlates of EE and proposed a diagnostic score model in a large contemporary cohort.

Methods: This is a retrospective observational study including patients with definite valve IE admitted between 2000 and 2023. EE were defined as acute complications causing overt clinical manifestations. The study primary aim was to identify independent correlates of EE.

Results: 715 valve-IE cases were included. EE occurred in 41.4% (n = 296) of patients. S. aureus etiology (OR 2.708[1.268-5.786]; p = 0.010), C-reactive protein > 6.7 mg/dL (OR 2.415[1.371-4.252]; p = 0.002), and splenomegaly (OR 2.858[1.620-5.403]; p < 0.001) were independently associated with EE. VS ≥ 14 mm (OR 1.575[0.925-2.682]; p = 0.061) and D-dimers > 747 ng/mL (OR 1.677[0.976-2.881]; p = 0.061) showed a trend for independent association. These variables were included in a diagnostic score model. A stepwise increase of EE occurrence was found stratifying patients into 3 categories (score 0-2-22%; score 3-5-53%; score 6-8-78%;p < 0.001). A cut-off of 2 (< 2 vs. ≥ 2) showed a sensitivity of 83% and a specificity of 50% (AUROC 0.732; p < 0.001).

Conclusion: EE were independently associated to Staphylococcus aureus, C-reactive protein and splenomegaly and less strongly linked to vegetation size in our cohort. These results may be explained by a change in embolic complications correlates linked to the epidemiological shift. The discriminative ability of our score was only fair. At present, clinicians should rely upon clinical and imaging data to diagnose EE.

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当代感染性心内膜炎大队列的栓塞并发症：我们需要评分模型吗？

目的：感染性心内膜炎（IE）是一种发生流行病学变化的异质性疾病。这些变化是否对栓塞事件（EE）的相关因素有影响尚不清楚。我们分析了情感表达的相关因素，并在一个大型当代队列中提出了一个诊断评分模型。方法：这是一项回顾性观察研究，包括2000年至2023年间入院的明确瓣膜IE患者。EE被定义为引起明显临床表现的急性并发症。该研究的主要目的是确定情感表达的独立相关因素。结果：共纳入715例瓣膜- ie病例。41.4% （n = 296）的患者发生EE。金黄色葡萄球菌病原学(OR 2.708[1.268-5.786]；p = 0.010), c反应蛋白> 6.7 mg / dL(或2.415 (1.371 - -4.252);p = 0.002)，脾肿大(OR 2.858[1.620-5.403]；p 747 ng/mL (OR 1.677[0.976-2.881]；P = 0.061)呈独立相关趋势。这些变量包含在诊断评分模型中。EE的发生率逐渐增加，将患者分为3类(评分0-2-22%；分3 - 5 - 53%;p结论：在我们的队列中，EE与金黄色葡萄球菌、c反应蛋白和脾肿大独立相关，与植被大小的相关性较弱。这些结果可以解释为栓子并发症的变化与流行病学的转变有关。我们的分数的辨别能力是公平的。目前，临床医生对EE的诊断主要依靠临床和影像学资料。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.