Vegetation size greater than 10 mm associated with increased risk of mortality in infective endocarditis

1. In this systematic review and meta-analysis, patients with infective endocardititis with vegetations greater than 10mm in size had significantly increased risk of systemic embolism and mortality.

Evidence Rating Level: 2 (Good)

Study Rundown: Infective endocarditis has many complications, many of which involve embolic events. The risk of embolism is said to be associated with vegetation size and many small observational studies have looked at this clinical question. This systematic review and meta-analysis aimed to study the association of vegetation size greater than 10mm with embolic events.

Vegetations greater than 10mm were associated with a statistically increased risk of both embolic events and mortality. There was a 2.3-times increased risk of embolic events and 63% increase in risk of mortality. Strengths of this study included robust methodology of a systematic review and meta-analysis including 21 studies of 6646 patients in total. Limitations included lack of information detailing antibiotic use and microbiology, and thus there was lack of statistical power to determine if risk of embolic events with vegetation size >10mm decreased with antibiotic therapy.

Click to read the study published in JAMA Internal Medicine

Relevant Reading: Vegetation size at diagnosis in infective endocarditis: Influencing factors and prognostic implications

In-Depth [meta-analysis]: This systematic review and meta-analysis used a computerized literature search in PubMed and EMBASE from inception to May 2017 to identify observational studies or randomized controlled trials evaluating the association of vegetation size greater than 10mm with embolic events in adults with infective endocarditis. Article eligibility was determined by two independent and blinded reviewers. Data was extracted by these independent reviewers adhering to PRISMA guidelines. The outcomes of interest included association of vegetation size with risk of embolic event and all-cause mortality. Mantel-Haenszel odds ratios and Higgins I² statistic were used for statistical analysis.

Twenty-one unique studies were identified, published from 1983 to 2016 with a total of 6646 patients. On meta-analysis, patients with vegetation sizes greater than 10 mm had increased odds of embolic events (OR 2.28; 95% CI 1.71-3.05; p < 0.001) and mortality (OR 1.63; 95% CI 1.13-2.35; p = 0.009).

Image: PD

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