Revisiting the effect of referral bias on the clinical spectrum of infective endocarditis in adults

Autor: Tatjana Lejko-Zupanc, Orathai Pachirat, Anqing Wang, David L. Gordon, Pierre Tattevin, Zeina A. Kanafani, Franz Wiesbauer, Souha S. Kanj, Vinod Thomas, R-S Tan, C H Cabell, Christian Michelet, Paul A. Pappas, A De Oliveira Ramos, Gail E. Peterson, Daniel J. Sexton, H Giamerellou, Enrico Cecchi, Patricia Muñoz
Přispěvatelé: American University of Beirut Medical Center (AUBMC), American University of Beirut [Beyrouth] (AUB), University Medical Center Ljubljana, Duke University Medical Center, Flinders Medical Centre, CHU Pontchaillou [Rennes], Clinical Microbiology and Infectious Diseases Department, Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), Khon Kaen University [Thailand] (KKU), Canberra Hospital, Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], University of Ljubljana
Rok vydání: 2009
Předmět:
Zdroj: European Journal of Clinical Microbiology and Infectious Diseases
European Journal of Clinical Microbiology and Infectious Diseases, Springer Verlag, 2010, 29 (10), pp.1203-10. ⟨10.1007/s10096-010-0983-2⟩
European Journal of Clinical Microbiology and Infectious Diseases, 2010, 29 (10), pp.1203-10. ⟨10.1007/s10096-010-0983-2⟩
ISSN: 1435-4373
0934-9723
DOI: 10.1007/s10096-010-0983-2⟩
Popis: International audience; Referral bias occurs because of the clustering of patients at tertiary care centers. This may result in the distortion of observed clinical manifestations of rare diseases. This analysis evaluates the effect of referral bias on the epidemiology of infective endocarditis (IE) in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS). This is a prospective multicenter cohort study comparing transferred and non-transferred patients with IE. Factors independently associated with transfer status were evaluated using multivariable logistic regression. A total of 2,760 patients were included in the analysis, of which 1,164 (42.2%) were transferred from other medical centers. Transferred patients more often underwent surgery for IE (odds ratio [OR] = 2.5; 95% confidence interval [CI] 1.9-3.2). They were also more likely to have complications such as stroke (OR = 1.5; 95% CI 1.3-1.9), heart failure (OR = 1.4; 95% CI 1.1-1.6), and new valvular regurgitation (OR = 1.3; 95% CI 1.1-1.6). The in-hospital mortality rates were similar in both groups. Patients with IE who require surgery and suffer complications are referred to tertiary hospitals more frequently than patients with an uncomplicated course. Hospital transfer has no obvious effect on the in-hospital mortality. Referral bias should be taken into consideration when describing the clinical spectrum of IE.
Databáze: OpenAIRE
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