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.
