Clinical implications in early diagnosis of infective endocarditis
Notice bibliographique
Résumé
Abstract Introduction The diagnostic delay of infective endocarditis (IE) is common due to its low clinical suspicion and often insidious course. An early diagnosis is essential for prompt treatment initiation and for preventing adverse outcomes. Purpose This study aims to analyze the time from the onset of symptoms to a confirmed diagnosis via echocardiography, considering the APORTEI score and microbiological identification, as well as implications for complications and mortality. Methods This was a retrospective observational study conducted on patients diagnosed with IE between 2016 and 2023. The comparison of the mean duration from symptom onset to diagnosis across different groups was performed using Student's t-test (for 2 groups) and ANOVA (for >2 groups). Post-hoc analyses were conducted when statistically significant differences were identified. Results Among a total of 188 patients (72.5% male; median age: 69 years, interquartile range [IQR]: 68), the median duration from the first symptom to diagnosis was 17 days (IQR: 4–92). Significant new-onset valvular dysfunction (including stenosis, insufficiency, or mixed lesions) was diagnosed in 65.6% of patients; however, no statistically significant differences were observed between the groups. Regarding the incidence of cerebral embolisms, systemic embolisms, and septic shock, there were no statistically significant differences. Differences in the time to diagnosis were observed between infections caused by different microorganisms (F[2,28] = 6, p = 0.04), particularly between S. bovis and S. aureus (p = 0.014), with earlier diagnosis noted in cases involving S. aureus. Significant differences were also found when stratifying by APORTEI risk score (low, moderate, high, and very high risk) (F[3,14] = 3, p = 0.027), with significance between low risk compared to high and very high risk (p = 0.03 and p = 0.027, respectively). Over a follow-up period of 28.4 months, 33.3% of patients died due to cardiovascular causes. These patients were diagnosed earlier, with a mean time to diagnosis of 15.2 days, whereas those who survived experienced a delay in the diagnosis, with a mean of 30.9 days (p = 0.02). Conclusions Patients with a poorer prognosis were those diagnosed earlier, probably due to a more aggressive disease course, which also coincided with more virulent microorganisms (E. coli, S. aureus) and higher risk stratifications according to the APORTEI score.Mean days and microorganismsMortality and mean days
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».