Early clinical course and long-term outcome of patients with infective endocarditis complicated by perivalvular abscess.
Bibliographic record
Abstract
BACKGROUND: Perivalvular abscess is an ominous development in patients with infective endocarditis. There is little information concerning the long-term outcome of these patients. METHODS: Patients admitted to a tertiary care centre in Ottawa between November 1987 and December 1995 because of infective endocarditis complicated by perivalvular abscess were identified by chart audit and by review of the transesophageal echocardiography database. The patients were followed for at least 4 years to determine cardiac complications, late cardiac surgery, long-term outcome and functional status. RESULTS: Forty-three consecutive patients with infective endocarditis and perivalvular abscess (32 men and 11 women; mean age 56 [standard deviation 16] years) were identified; 17 had native valve endocarditis and 26 had prosthetic valve endocarditis. Of the 43 patients, 31 had cardiac surgery during the hospital stay; 6 died in hospital, and 10 died during follow-up. Twelve patients received medical treatment alone; none died in hospital, and 8 died during follow-up. The medically treated patients had less severe heart failure than the surgically treated patients (p = 0.12), but the 2 groups were similar in age and infective organisms. After a mean of 4.5 years of follow-up, the cumulative death rate was 57%; survival was similar among the medically and surgically treated patients. The survivors were younger than the nonsurvivors (p = 0.04). Complications of perivalvular abscess, including pseudoaneurysms and fistulae, were common, occurring in all medically treated patients and in 10 of the 24 surgically treated patients who had follow-up transesophageal echocardiography. INTERPRETATION: Patients with infective endocarditis and perivalvular abscess had a high rate of death after hospital discharge and a high incidence of complications of perivalvular abscess, despite early surgical intervention in most patients. Lower age was the only predictor of long-term survival.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".