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Eur Heart J. 2011 Aug;32(16):2016-26. doi: 10.1093/eurheartj/ehp085. Epub 2009 Mar 28.

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

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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.



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.


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.


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

[Indexed for MEDLINE]

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