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Description

Park et al reported a model for 6-month mortality associated with infective endocarditis. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions from around the world and belong to the International Collaboration on Endocarditis (ICE) Investigators.


Patient selection: infective endocarditis

 

Outcome: 6-month mortality

 

Parameters:

(1) age in years

(2) history of dialysis

(3) nosocomial infective endocarditis

(4) prosthetic infective endocarditis

(5) duration of symptoms prior to admission in months

(6) isolated organism

(7) aortic vegetation

(8) mitral vegetation

(9) NYHA heart failure

(10) stroke

(11) paravalvular complication

(12) persistent bacteremia

(13) surgical treatment

 

Parameter

Finding

Points

age in years

<= 45

0

 

46 to 60

2

 

61 to 70

3

 

> 70

4

history of dialysis

no

0

 

yes

3

nosocomial endocarditis

no

0

 

yes

2

prosthetic valve endocarditis

no

0

 

yes

1

symptoms before admission

<= 1 month

0

 

> 1 month

-1

organism

Staphylococcus aureus

1

 

viridans Streptococcus

-2

 

other

0

aortic vegetation

no

0

 

yes

1

mitral vegetation

no

0

 

yes

1

NYHA heart failure

none, NYHA I, NYHA II

0

 

NYHA III or IV

3

stroke

no

0

 

yes

2

paravalvular complication

no

0

 

yes

2

persistent bacteremia

no

0

 

yes

2

surgical treatment

no

0

 

yes

-2

 

total score =

= SUM(points for all of the parameters) + 4

 

Interpretation:

minimum score: 0 or -1 (the constant 4 was added to avoid a negative number)

maximum score: 26

A score >= 8 had a sensitivity of 87% and specificity of 51% for 6-month mortality, with a negative predictive value of 87%.

 

probability of 6-month mortality =

= (0.109 * ((score)^2)) + (2.416 * (score)) - 4.849

 

Performance:

The area under the ROC curve is 0.72 in the derivation cohort and 0.68 in the validation cohort.


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