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Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study
INTRODUCTION: Accurate prediction of embolic events in infective endocarditis could inform critical clinical decisions, such as the timing of cardiac surgical intervention. However, many embolic events occur before hospital admission and echocardiography and are thus non-modifiable. We aimed to iden...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483226/ https://www.ncbi.nlm.nih.gov/pubmed/31022279 http://dx.doi.org/10.1371/journal.pone.0215924 |
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author | Yang, Alvin Tan, Charlie Adhikari, Neill K. J. Daneman, Nick Pinto, Ruxandra Haynen, Bennett K. M. Cohen, Gideon Hansen, Mark S. |
author_facet | Yang, Alvin Tan, Charlie Adhikari, Neill K. J. Daneman, Nick Pinto, Ruxandra Haynen, Bennett K. M. Cohen, Gideon Hansen, Mark S. |
author_sort | Yang, Alvin |
collection | PubMed |
description | INTRODUCTION: Accurate prediction of embolic events in infective endocarditis could inform critical clinical decisions, such as the timing of cardiac surgical intervention. However, many embolic events occur before hospital admission and echocardiography and are thus non-modifiable. We aimed to identify time-sensitive variables that predict embolic events in infective endocarditis, focusing on those that occur after diagnosis. METHODS: Clinical, microbiological, and echocardiographic characteristics were collected from 116 patients with definite or probable left-sided infective endocarditis admitted to Sunnybrook Health Sciences Centre (Toronto, Canada) between October 2013 and July 2016; associations between these characteristics and embolic events were identified using simple logistic regression. RESULTS: The mean (SD) age was 66 (17) years; 82 patients (71%) were men. The most frequent microorganisms were Staphylococcus aureus (23%) and viridans group streptococci (21%). Seventy-nine (68%) patients had left-sided vegetations, with involvement of the aortic valve in 34 (43%) patients, mitral valve in 37 (47%) patients, and both in 8 (10%) patients. The mean (SD) vegetation size was 10 (7) mm. Forty-three unique patients (37%) had 50 embolic events, with most (34/43; 79%) having a first embolic event (38/50; 76%) before or on the day of echocardiography. There were no significant predictors of the 11 patients with an embolic event after echocardiography; significant predictors of an embolic event at any time were single valve vegetation vs. no vegetation (OR, 4.75; 95% confidence interval [CI], 1.76–12.78) and, among patients with a vegetation, mitral vs. aortic valve location (OR, 4.43; 95%CI, 1.63–12.04). CONCLUSIONS: Associations between patient and echocardiographic characteristics and embolism in patients with infective endocarditis may be time-sensitive, as few embolic events occurred after clinical and echocardiographic assessment. |
format | Online Article Text |
id | pubmed-6483226 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-64832262019-05-09 Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study Yang, Alvin Tan, Charlie Adhikari, Neill K. J. Daneman, Nick Pinto, Ruxandra Haynen, Bennett K. M. Cohen, Gideon Hansen, Mark S. PLoS One Research Article INTRODUCTION: Accurate prediction of embolic events in infective endocarditis could inform critical clinical decisions, such as the timing of cardiac surgical intervention. However, many embolic events occur before hospital admission and echocardiography and are thus non-modifiable. We aimed to identify time-sensitive variables that predict embolic events in infective endocarditis, focusing on those that occur after diagnosis. METHODS: Clinical, microbiological, and echocardiographic characteristics were collected from 116 patients with definite or probable left-sided infective endocarditis admitted to Sunnybrook Health Sciences Centre (Toronto, Canada) between October 2013 and July 2016; associations between these characteristics and embolic events were identified using simple logistic regression. RESULTS: The mean (SD) age was 66 (17) years; 82 patients (71%) were men. The most frequent microorganisms were Staphylococcus aureus (23%) and viridans group streptococci (21%). Seventy-nine (68%) patients had left-sided vegetations, with involvement of the aortic valve in 34 (43%) patients, mitral valve in 37 (47%) patients, and both in 8 (10%) patients. The mean (SD) vegetation size was 10 (7) mm. Forty-three unique patients (37%) had 50 embolic events, with most (34/43; 79%) having a first embolic event (38/50; 76%) before or on the day of echocardiography. There were no significant predictors of the 11 patients with an embolic event after echocardiography; significant predictors of an embolic event at any time were single valve vegetation vs. no vegetation (OR, 4.75; 95% confidence interval [CI], 1.76–12.78) and, among patients with a vegetation, mitral vs. aortic valve location (OR, 4.43; 95%CI, 1.63–12.04). CONCLUSIONS: Associations between patient and echocardiographic characteristics and embolism in patients with infective endocarditis may be time-sensitive, as few embolic events occurred after clinical and echocardiographic assessment. Public Library of Science 2019-04-25 /pmc/articles/PMC6483226/ /pubmed/31022279 http://dx.doi.org/10.1371/journal.pone.0215924 Text en © 2019 Yang et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Yang, Alvin Tan, Charlie Adhikari, Neill K. J. Daneman, Nick Pinto, Ruxandra Haynen, Bennett K. M. Cohen, Gideon Hansen, Mark S. Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study |
title | Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study |
title_full | Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study |
title_fullStr | Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study |
title_full_unstemmed | Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study |
title_short | Time-sensitive predictors of embolism in patients with left-sided endocarditis: Cohort study |
title_sort | time-sensitive predictors of embolism in patients with left-sided endocarditis: cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483226/ https://www.ncbi.nlm.nih.gov/pubmed/31022279 http://dx.doi.org/10.1371/journal.pone.0215924 |
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