The usefulness of serum troponin levels to predict 1-year survival rates in infective endocarditis
TL;DR: IE has poor outcome and baseline troponin T levels may predict long-term survival rates in patients with IE, and patient with elevated trop onin levels were older, were more likely to be male and tended to have enterococcal infection.
About: This article is published in International Journal of Infectious Diseases.The article was published on 2015-05-01 and is currently open access. It has received 11 citations till now. The article focuses on the topics: Troponin T & Hazard ratio.
Citations
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TL;DR: Evaluating potential diagnostic biomarkers for bacterial infective endocarditis found N-terminal-pro-B-type natriuretic peptide alone or in combination with Cystatin C, lipopolysaccharide-binding protein (LBP), troponins, aquaporin-9 (AQP9), S100 calcium binding protein A11 (S100A11), E-selectin (CD62E) and VCAM-1 (CD54)
24 citations
TL;DR: S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE, and after 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance.
14 citations
TL;DR: Inpatient mortality was higher in patients with IE and elevated cardiac troponin levels compared to patients with normal levels and the role of serum trop onin levels measurements as a marker of increased mortality was evaluated.
Abstract: Despite recent improvement in management, infective endocarditis (IE) continues to be associated with considerable risk of morbidity and mortality. Early identification of predictors of inpatient mortality is key in improving patient outcomes in IE. The aim of our study was to evaluate the role of serum troponin levels measurements as a marker of increased mortality. A case-control study included adult patients with IE admitted to a tertiary care hospital in east Tennessee between December 2012 and July 2017. Cases were defined as patients with definitive IE who died in-hospital; controls were patients who did not die in hospital. First patient admission was included only. Data collected included the patients’ demographic and baseline clinical information, microbiological data, injection drug use status, elevated serum troponins levels. Two hundred eighty three patients with definitive IE were included; median (IQR) age was 41 (30–57) years, and 153 (54%) patients were men. One-hundred sixty-four (58%) were injection drug users. The most frequent IE type was: 167 (59%) right-sided, 86 (30%) left-sided, 24 (9%) both left and right-sided, and 10 (4%) device related. The most commonly isolated organism was Staphylococcus aureus (n = 141), and 64% were methicillin-resistant. Two-hundred twelve (75%) patients had a troponin level obtained, and 57 (27%) had an elevated troponin value. Thirty-six (13%) patients died in-hospital; in-hospital mortality was associated elevated troponin values (adjusted odds ratio [adjOR], 7.3; 95%CI, 3.3–15.9), and methicillin-resistant S. aureus IE (adjOR 2.6; 95%CI, 1.2–5.8). Forty-four (16%) patients received IE valve surgery, and none of these patients died in the hospital. Inpatient mortality was higher in patients with IE and elevated cardiac troponin levels compared to patients with normal levels.
6 citations
TL;DR: In this paper, the authors synthesize the prognostic value of troponin (Tn) in patients with endocarditis and show that Tn elevation is associated with a poor prognosis.
Abstract: AIMS Infective endocarditis (IE) is associated with high mortality and morbidity. Cardiac troponin (Tn) elevation seems to be common in patients with IE and could be associated with a poor prognosis. The aim of this study was to synthesize the prognostic value of Tn in patients with IE. METHODS AND RESULTS We searched in MEDLINE, EMBASE, and the Cochrane library, including the Cochrane Central Register of Controlled Trials (CENTRAL) until February 2020. Observational studies reporting on the association between Tn and in-hospital and 1-year mortality, and IE complications were considered eligible. As each centre uses different conventional or ultra-sensitive Tn, with different normality threshold, we considered them as normal or elevated according to the criteria specified in each article. Articles were systematically selected, assessed for bias, and, when possible, meta-analysed using a random effect model. After retrieving 542 articles, 18 were included for qualitative synthesis and 9 for quantitative meta-analysis. Compared with patients with normal Tn levels, patients with Tn elevation presented higher in-hospital mortality [odds ratio (OR) 5.96, 95% confidence interval (CI) 3.46-10.26; P < 0.0001], 1-year mortality (OR 2.67, 95% CI 1.42-5.02; P = 0.002), and surgery rates (OR 2.34, 95% CI 1.42-3.85; P = 0.0008). They also suffered more frequent complications: central nervous system events (OR 8.85, 95% CI 3.23-24.26; P < 0.0001) and cardiac abscesses (OR 4.96, 95% CI 1.94-12.70; P = 0.0008). CONCLUSION Tn elevation is associated with a poor prognosis in patients with IE. Troponin determination seems to provide additional help in the prognostic assessment of these patients.
6 citations
TL;DR: TnT elevation is very common in patients with infective endocarditis and is associated with increased in-hospital mortality and complications, thus routine monitoring should be recommended.
6 citations
References
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TL;DR: Modifications of the Duke criteria for the diagnosis of infective endocarditis are proposed, including that positive Q-fever serology should be changed to a major criterion and the minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated.
Abstract: Although the sensitivity and specificity of the Duke criteria for the diagnosis of infective endocarditis (IE) have been validated by investigators from Europe and the United States, several shortcomings of this schema remain. The Duke IE database contains records collected prospectively on >800 cases of definite and possible IE since 1984. Databases on echocardiograms and on patients with Staphylococcus aureus bacteremia at Duke University Medical Center are also maintained. Analyses of these databases, our experience with the Duke criteria in clinical practice, and analysis of the work of others have led us to propose the following modifications of the Duke schema. The category "possible IE" should be defined as having at least 1 major criterion and 1 minor criterion or 3 minor criteria. The minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated, given the widespread use of transesophageal echocardiography (TEE). Bacteremia due to S. aureus should be considered a major criterion, regardless of whether the infection is nosocomially acquired or whether a removable source of infection is present. Positive Q-fever serology should be changed to a major criterion.
3,330 citations
"The usefulness of serum troponin le..." refers methods in this paper
...Between January 2008 and January 2011, 84 consecutive patients diagnosed with definite IE according to the modified Duke criteria were enrolled [8]....
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TL;DR: In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection, and Mortality remains relatively high.
Abstract: (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.131.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.643.09) were associated with an increased risk of inhospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. Conclusions: In the early 21st century, IE is more often an acute disease, characterized by a high rate ofS aureus infection. Mortality remains relatively high.
1,816 citations
TL;DR: Standards for the assessment of mitral and tricuspid regurgitation are provided to understand mechanisms of Regurgitation, quantification of its severity and repercussions.
Abstract: Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation.
1,398 citations
TL;DR: Simultaneous continuous wave Doppler echocardiography and right-sided cardiac pressure measurements were performed during cardiac catheterization in 127 patients and approximately 80% of patients with increased and 57% with normal right ventricular pressure had analyzable Dopplers tricuspid regurgitant velocities that could be used to accurately predictright ventricular systolic pressure.
980 citations
"The usefulness of serum troponin le..." refers methods in this paper
...Continuous-wave Doppler of the tricuspid regurgitation jet signal using the Bernoulli equation estimated pulmonary artery systolic pressure [10]....
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TL;DR: Staphylococcus aureus has emerged as a dominant cause of IE, and is an independent predictor of mortality, in patients with definite or possible IE at Duke University Medical Center from 1993 to 1999.
Abstract: Background: Limited data exist on recent demographic and microbiological changes in infective endocarditis (IE) and the impact of these changes on patient survival. Methods: Data were collected from all patients with definite or possible IE at Duke University Medical Center, Durham, NC, from 1993 to 1999. Logistic regression analysis was used to identify demographic and microbiological changes that occurred in patients with IE over the study period. The impact of these changes on survival was evaluated using Cox proportional hazards modeling. Results: Among the 329 study patients, rates of hemodialysis dependence, immunosuppression, and Staphylococcus aureus infection increased during the study period (P=.04, P=.008, and P.001, respectively), while rates of infection due to viridans group streptococci decreased (P=.007). Hemodialysis was independently associated with S aureus infection (odds ratio, 3.1; 95% confidence interval, 1.6-5.9). Patients with S aureus IE had a higher 1-year mortality rate (43.9% vs 32.5%; P=.04) that persisted after adjustment for other illness severity characteristics (hazard ratio, 1.5; 95% confidence interval, 1.03-2.3). Conclusions: The demographic and microbiological characteristics of IE at our institution have changed over the past decade in ways that suggest a link between medical practice and IE characteristics. Staphylococcus aureus has emerged as a dominant cause of IE, and is an independent predictor of mortality. These findings identify clinical settings that may warrant closer surveillance and more aggressive measures in the identification and prevention of endocarditis. Arch Intern Med. 2002;162:90-94
503 citations
"The usefulness of serum troponin le..." refers background in this paper
...In-hospital mortality rates range from 10% to 20%, while long-term mortality rates can be much higher [1–3]....
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