Predicting Prognosis in Infective Endocarditis
Predicting Prognosis in Infective Endocarditis
The term "infective endocarditis" (IE) is used to describe a set of clinically different entities. The morbidity and mortality of IE remains high. Right sided native valve IE generally takes a more benign course and even short-term antibiotic regimen can be successful. Prosthetic valve IE, by contrast, is a severe, life-threatening disease requiring different therapeutic measures. In IE, known predictors of clinical outcome are age, vegetation size and the causative organism. Still, individual clinical courses differ significantly.
Thus, a biomarker for the prediction of prognosis and the identification of the etiological pathogen at the initial evaluation of patients with IE would be very valuable and helpful. A biomarker strategy could allow early identification of high-risk IE patients needing more aggressive therapy. Up to now, C-reactive protein (CRP) has been studied as a predictor of clinical course in IE. Serial measurements showing elevated serum CRP levels > 122 mg/dl one and > 62 mg/dl four weeks after initiation of treatment have shown to predict poor outcome, but initial serum levels of CRP at time of diagnosis failed to predict the clinical course.
Procalcitonin (PCT) is widely used in critically ill patients to diagnose clinical significant infection and sepsis. In IE patients undergoing heart valve replacement, PCT showed typical postoperative kinetics with a peak 3 days after surgery but failed to predict complications of surgery. It has also been found to be a valuable diagnostic marker in IE, but its prognostic value has not yet been investigated.
The aim of this study was therefore to evaluate the prognostic value of PCT for clinical outcome including death and serious complications and its correlation with microbiological etiology in patients with IE.
Background
The term "infective endocarditis" (IE) is used to describe a set of clinically different entities. The morbidity and mortality of IE remains high. Right sided native valve IE generally takes a more benign course and even short-term antibiotic regimen can be successful. Prosthetic valve IE, by contrast, is a severe, life-threatening disease requiring different therapeutic measures. In IE, known predictors of clinical outcome are age, vegetation size and the causative organism. Still, individual clinical courses differ significantly.
Thus, a biomarker for the prediction of prognosis and the identification of the etiological pathogen at the initial evaluation of patients with IE would be very valuable and helpful. A biomarker strategy could allow early identification of high-risk IE patients needing more aggressive therapy. Up to now, C-reactive protein (CRP) has been studied as a predictor of clinical course in IE. Serial measurements showing elevated serum CRP levels > 122 mg/dl one and > 62 mg/dl four weeks after initiation of treatment have shown to predict poor outcome, but initial serum levels of CRP at time of diagnosis failed to predict the clinical course.
Procalcitonin (PCT) is widely used in critically ill patients to diagnose clinical significant infection and sepsis. In IE patients undergoing heart valve replacement, PCT showed typical postoperative kinetics with a peak 3 days after surgery but failed to predict complications of surgery. It has also been found to be a valuable diagnostic marker in IE, but its prognostic value has not yet been investigated.
The aim of this study was therefore to evaluate the prognostic value of PCT for clinical outcome including death and serious complications and its correlation with microbiological etiology in patients with IE.
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