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European Heart Journal Advance Access published online on March 28, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp085
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Development and validation of a time-dependent risk model for predicting mortality in infective endocarditis

Raymond W. Sy1,2, Chirapan Chawantanpipat2, David R. Richmond2 and Leonard Kritharides1,*

1 Department of Cardiology, 3rd floor West, Concord Repatriation General Hospital, Sydney South Western Area Health Service, University of Sydney, Hospital Rd, Concord, NSW 2139, Australia
2 Department of Cardiology, Royal Prince Alfred Hospital, Sydney South Western Area Health Service, University of Sydney, Sydney, NSW, Australia

Received 27 May 2008; revised 5 January 2009; accepted 18 February 2009 * Corresponding author. Tel: +612 9767 6296, Fax: +612 9767 6994, Email: lenk{at}med.usyd.edu.au

Aims: Existing risk models in infective endocarditis (IE) have not investigated whether the prognostic value of clinical parameters is time-dependent. We have explored the potential of time-dependent risk stratification to predict outcome in IE.

Methods and results: We studied 273 patients admitted with IE to two centres (derivation cohort n = 192, validation cohort n = 81). The derivation cohort was used to identify independent predictors of 6 months mortality at days 1, 8, and 15 (multivariable Cox regression, P < 0.05). There were six predictors at day 1, five at day 8, and only three at day 15. Whereas heart failure, thrombocytopenia, and severe comorbidity predicted mortality at all three time-points, other predictors were time-dependent (age, tachycardia, renal impairment at day 1; severe embolic events, renal impairment at day 8). These predictors were incorporated into a time-dependent model. The model was validated in an independent cohort with concordance indices of 0.79 (95% CI 0.68–0.91) at day 1, 0.79 (95% CI 0.65–0.93) at day 8, and 0.84 (95% CI 0.73–0.95) at day 15. Six months mortality was 2.4% in patients deemed as low-risk at all time-points, compared with 78.2% in patients classified as high-risk at any evaluation.

Conclusion: Prognostic factors in IE are time-dependent. Time-dependent risk stratification accurately predicts outcome in IE.

Key Words: Endocarditis • Risk factors • Mortality • Prognosis


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