San Román, Jose AlbertoLópez, JavierVila Costa, IsidroSarriá, CRevilla, ARonderos, RStoermann, WGómez, IFernández-Avilés Díaz, Francisco JesúsLuaces Méndez, María2024-02-092024-02-092007-04-01San Román JA, López J, Vilacosta I, Luaces M, Sarriá C, Revilla A, Ronderos R, Stoermann W, Gómez I, Fernández-Avilés F. Prognostic stratification of patients with left-sided endocarditis determined at admission. Am J Med. 2007 Apr;120(4):369.e1-7. doi: 10.1016/j.amjmed.2006.05.071. PMID: 17398233.0002-934310.1016/j.amjmed.2006.05.071https://hdl.handle.net/20.500.14352/101058Background: The prognosis of patients with left-sided endocarditis remains poor despite the progress of surgical techniques. Identification of high-risk patients within the first days after admission to the hospital would permit a more aggressive therapeutic approach. Methods: We designed a prospective multicenter study to find out the clinical, microbiologic, and echocardiographic characteristics available within 72 hours of admission that might define the profile of high-risk patients. Of 444 episodes, 317 left-sided endocarditis cases were included and 76 variables were assessed. Events were surgery in the active phase of the disease and in-hospital death. A stepwise logistic regression analysis was undertaken to determine variables predictive of events. Results: Multivariate analysis of the clinical variables found to have statistical significance in the univariate analysis identified the following as predictive: patient referred from another hospital (odds ratio [OR]: 1.8; confidence interval [CI], 1.1-2.9), atrioventricular block (OR: 2.5; CI, 1.1-5.9), acute onset (OR: 1.7; CI, 1.1-2.9), and heart failure at admission (OR: 2.3; CI, 1.4-3.8). When the echocardiographic and microbiological variables statistically significant in the univariate analysis were introduced, the presence of heart failure at admission (OR: 2.9; CI, 1.8-4.8), periannular complications (OR: 1.8; CI, 1.1-3.1), and Staphylococcus aureus infection (OR: 2.0; CI, 1.1-3.8) retained prognostic power. Risk could be accurately stratified when combining the 3 variables with predictive power: 0 variables present: 25% of risk; 1 variable present: 38% to 49% of risk; 2 variables present: 56% to 66% of risk; and 3 variables present: 79% of risk. Conclusions: The risk of patients with left-sided endocarditis can be accurately stratified with the assessment of variables easily available within 72 hours of admission to the hospital.engjournal articlehttps://www.sciencedirect.com/science/article/pii/S0002934306012071?via%3Dihubrestricted access612Ciencias Biomédicas32 Ciencias Médicas