{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T18:24:49Z","timestamp":1792607089997,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"15","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2003,4,16]]},"abstract":"<jats:sec><jats:title>Context<\/jats:title><jats:p>Complicated left-sided native valve endocarditis causes significant morbidity and mortality in adults. Lack of valid data regarding estimation of prognosis makes management of this condition difficult.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To derive and externally validate a prognostic classification system for adults with complicated left-sided native valve endocarditis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Patients<\/jats:title><jats:p>Retrospective observational cohort study conducted from January 1990 to January 2000 at 7 Connecticut hospitals among 513 patients older than 16 years who experienced complicated left-sided native valve endocarditis and who were divided into derivation (n = 259) and validation (n = 254) cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure<\/jats:title><jats:p>All-cause mortality at 6 months after baseline.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the derivation and validation cohorts, the 6-month mortality rates were 25% and 26%, respectively. Five baseline features were independently associated with 6-month mortality (comorbidity [<jats:italic>P<\/jats:italic> = .03], abnormal mental status [<jats:italic>P<\/jats:italic> = .02], moderate to severe congestive heart failure [<jats:italic>P<\/jats:italic> = .01], bacterial etiology other than viridans streptococci [<jats:italic>P<\/jats:italic>&amp;amp;lt;.001 except <jats:italic>Staphylococcus aureus, P<\/jats:italic> = .004], and medical therapy without valve surgery [<jats:italic>P<\/jats:italic> = .002]) and were used to create a prognostic classification system. In the derivation cohort, patients were classified into 4 groups with increasing risk for 6-month mortality: 5%, 15%, 31%, and 59% (<jats:italic>P<\/jats:italic>&amp;amp;lt;.001). In the validation cohort, a similar risk among the 4 groups was observed: 7%, 19%, 32%, and 69% (<jats:italic>P<\/jats:italic>&amp;amp;lt;.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adults with complicated left-sided native valve endocarditis can be accurately risk stratified using baseline features into 4 groups of prognostic severity. This prognostic classification system might be useful for facilitating management decisions.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.289.15.1933","type":"journal-article","created":{"date-parts":[[2003,4,15]],"date-time":"2003-04-15T23:21:07Z","timestamp":1050448867000},"page":"1933","source":"Crossref","is-referenced-by-count":270,"title":["Complicated Left-Sided Native Valve Endocarditis in Adults"],"prefix":"10.1001","volume":"289","author":[{"given":"Rodrigo","family":"Hasbun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holenarasipur R.","family":"Vikram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia A.","family":"Barakat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Buenconsejo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent 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