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Inicio Medicina Clínica (English Edition) Left-sided native valve infective endocarditis: Influence of age and the presenc...
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Vol. 147. Issue 11.
Pages 475-480 (December 2016)
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Vol. 147. Issue 11.
Pages 475-480 (December 2016)
Original article
DOI: 10.1016/j.medcle.2016.12.023
Left-sided native valve infective endocarditis: Influence of age and the presence of underlying heart disease
Endocarditis infecciosa sobre válvula nativa del lado izquierdo: influencia de la edad y de cardiopatía previa
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Francisco José Castillo Bernal
Corresponding author
fjcasber@hotmail.com

Corresponding author.
, Manuel Pablo Anguita Sánchez, Juan Carlos Castillo Domínguez, Francisco Carrasco Ávalos, Martín Ruiz Ortiz, Mónica Delgado Ortega, Elías Romo Peñas, Dolores Mesa Rubio, José Suárez de Lezo Cruzconde
Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Tables (5)
Table 1. Baseline characteristics of the overall series of left-sided native valve infective endocarditis.
Table 2. Clinical and microbiological characteristics, complications, surgery and mortality rate in the overall series (No.=257).
Table 3. Independent hospital mortality predictive factors in the overall series. Multiple logistic regression analysis (No.=257).
Table 4. Clinical and microbiological characteristics, complications, surgery and mortality rate in patients without heart disease (No.=109).
Table 5. Independent predictive factors of hospital mortality in patients without heart disease. Multiple logistic regression analysis (No.=109).
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Abstract
Introduction and objectives

Left-sided native valve infective endocarditis (LNVIE) epidemiology has been modified as a result of the increase in average age. The aim of our study is to analyse the influence of age and the presence of predisposing heart disease in the prognosis of these patients.

Methods

We analysed a series of 257 cases of LNVIE depending on their age (greater than or equal to 70 years old), both in the overall series and in the subgroup of patients without predisposing heart disease.

Results

Mean age was 54.6 (18.6) years. There was an increase in the percentage of cases of older patients between 1987–2000 and 2001–2014 (9.8 vs. 34.8%, p<0.001). These patients present higher prevalence of degenerative valves (50 vs. 22.8%) or not predisposing heart disease (50 vs. 39.9%), p<0.001, health-care associated episodes (41.8 vs. 23.6%, p=0.016), lower rate of surgery (43.7 vs. 63.8%, p=0.005) and higher in-hospital mortality (39.1 vs. 20.7%, p=0.003), with no differences in comorbidities. Older patients who did not have predisposing heart disease also suffered higher in-hospital mortality (47 vs. 22%, p=0.01). Age greater than or equal to 70 years old is an independent predictor of mortality in patients with LNVIE (OR 2.53, 95% CI 1.24–5.15, p=0.011), as in those without previous heart disease (OR 3.98, 95% CI 1.49–10.62, p=0.006).

Conclusions

Patients of age greater than or equal to 70 years old and who suffer an LNVIE are becoming more frequent and have a worse prognosis with a lower rate of surgery and higher rates of in-hospital mortality.

Keywords:
Infective endocarditis
Native valve
Age
Resumen
Introducción y objetivos

La epidemiología de la endocarditis infecciosa sobre válvula nativa izquierda (EIVNI) se ha modificado, consecuencia del aumento en la edad media de los pacientes. El objetivo de nuestro estudio es analizar la influencia de la edad y la presencia de una cardiopatía predisponente previa en el pronóstico de estos pacientes.

Métodos

Analizamos 257 casos consecutivos de EIVNI en función de su edad, tanto en la serie global como en el subgrupo de pacientes sin cardiopatía predisponente.

Resultados

La edad media fue de 54,6 (18,6) años. Existió un aumento en la proporción de pacientes de edad igual o mayor a 70 años entre 1987–2000 y 2001–2014 (9,8 frente a 34,8%, p<0,001), que presentaban una mayor prevalencia de valvulopatía degenerativa (50 frente a 22,8%), ausencia de cardiopatía (50 frente a 39,9%), p<0,001, casos relacionados con atención sanitaria (41,8 frente a 23,6%, p=0,016), menor tasa de cirugía (43,7 frente a 63,8%, p=0,005) y mayor mortalidad hospitalaria (39,1 frente a 20,7%, p=0,003), sin diferencias respecto a comorbilidades. Los pacientes sin cardiopatía también presentaron una mortalidad hospitalaria más elevada (47 frente a 22%, p=0,01). La edad igual o mayor a 70 años constituye un predictor independiente de mortalidad en pacientes con EIVNI (OR 2,53, IC 95% 1,24–5,15, p=0,011), igual que en aquellos que no presentan cardiopatía (OR 3,98, IC 95% 1,49–10,62, p=0,006).

Conclusiones

Los pacientes que tienen una edad igual o mayor a 70 años con un episodio de EIVNI son cada vez más frecuentes y presentan peor pronóstico, con una tasa menor de cirugía y mayores tasas de mortalidad hospitalaria.

Palabras clave:
Endocarditis infecciosa
Válvula nativa
Edad

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