Description

Sy et al reported a set of time-dependent risk models for a patient with infective endocarditis. These can help to identify a patient who may require more aggressive management. The authors are from Concord Repatriation General Hospital, University of Sydney and Royal Prince Albert Hospital in Australia.


Patient selection: infective endocarditis

 

Outcome: 6-month mortality

 

Parameters for the risk model on day 1 of hospitalization (baseline):

(1) age in years

(2) Charlson comorbidity index

(3) pulse rate in beats per minute

(4) congestive heart failure

(5) platelet count in 10^9/L

(6) serum creatinine in µmol/L

 

Parameter

Finding

Points

age in years

< 65 years

0

 

>= 65 years

2

Charlson comorbidity

< 3

0

 

>= 3

2

pulse

< 120 beats per minute

0

 

>= 120 beats per minute

3

congestive heart failure

no

0

 

yes

2

platelet count

>= 150 * 10^9/L

0

 

< 150 * 10^9/L

2

serum creatinine

< 120 µmol/L

0

 

>= 120 µmol/L

4

 

total score =

= SUM(points for all 6 parameters)

 

Interpretation:

minimum score: 0

maximum score: 15

 

Score

Risk Group

Mortality

0 to 3

low

9%

4 to 9

intermediate

32%

10 to 15

high

81%

from Figure 3

 

A patient judged to be at low-risk on days 1, 8 and 15 had a 6-month mortality of 2.4%

A patient judged high risk on any of the days had a 6-month mortality of 78%

Everyone else had a 6-month mortality of 20%.

 

Performance:

The area under the ROC curve is 0.79.


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